Creative Impact Printable Order Form

To order, print out this order form, fill it in, and mail or fax it to us.  Mastercard and Visa accepted.  Prices & Shipping Costs follow.

Item   Description         Quantity  Price     Subtotal  Shipping   Total
Number                               Ea. Item            & Handling
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|_____|___________________|_________|__________|________|__________|________|
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|_____|___________________|_________|__________|________|__________|________|
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                                       Sales Tax (where applicable) ________
Total Amount Due (subtotal + shipping + tax)........................________
                
Name:_______________________________________________________________________

Organization: ______________________________________________________________

Shipping Address:___________________________________________________________

City/State: __________________________________  Zip: _______________________
Country:______________________________________  Code:_______________________

E-mail address: ______________________________  Phone: _____________________

Method of Payment:

[   ]Check   [  ]Money order   [  ]Purchase Order  [  ]Mastercard  [  ]Visa

Mail to:                         Credit Card info:     
Creative Impact                       
945 40th Street
West Des Moines, Iowa  50265     __________________________________
                                 Card Number

Fax to:                          ____/____
(515) 223-2250                   Expiration Date

                                 __________________________________
                                 Signature

Prevention Products Price List
Call for large quantity pricing.

Bottles With Impact
Small, four-ounce Bottles #054
Quantity Price / Bottle
01 - 05 $17.95
06 - 15 $16.95
16 - 25 $15.95
26 - 50 $14.95
Grade-2 Bottles: $10 each
Large, eight-ounce Bottles #058
Quantity Price / Bottle
01 - 05 $24.95
06 - 15 $22.95
16 - 25 $20.95
26 - 50 $18.95
Grade-2 Bottles: $15 each

The Apparent Parent
Bookmarks (Drugs: #044 Violence:#045)
Quantity  Price / Bookmark
 010 - 500 $.15
 501 - 1500 $.14 
1501 - 2000 $.12
2001 + $.10
 Brochures (Drugs: #046 Violence:#047)
Quantity  Price / Brochure
010 -500 $.18
501 - 1500 $.17
1501 - 2000 $.16
2001 + $.14
Apparent Parent Mugs #048
Quantity  Price / Mug
001 -10 $5.00 
011 - 20 $4.75
021 - 50  $4.25

The Men's Room
Loser Sperm Line-Up #030A
Which Sperm #030B
Smart Eggs #030C
Quantity Price / Poster
01 - 25 $4.75
26 - 50 $4.50
51 - 100 $4.00
One of each design $12.75/set

Reminder Bead Kits
 Bracelet or Necklace Kits #080
Quantity   Price / Kit
05 - 50  $2.00
51 - 150  $1.75
151 + $1.50
Add $1 per kit for stringing.
Key Chain Kits #082
Quantity  Price / Kit
05 - 50 $2.85
51 - 300  $2.60
301 + $2.35
Add $1.50 per kit for stringing & assembling.

Shipping and Handling

When ordering a combination of products or from outside the United States, please call 1-800-846-4903 (8 a.m. to 6 p.m. CST) for lowest shipping rates.
Display Bottles and Apparent Parent mugs
Quantity  Shipping
1  $5.95
2  $6.95
3  $7.95
4  $8.95
5  $9.95
Add $.50 for each additional Bottle and/or mug
Brochures and Bookmarks
Quantity Shipping
050 – 099  $3.95
100 – 199 $4.95
200 – 499  $6.95
500 – 799 $7.95
800 – 1000  $8.95
For orders of more than 1,000 pieces, please call for lowest shipping price.
Posters (includes mailing tube)
Quantity Shipping
01 – 09  $4.95
10 – 20  $6.95
21 – 30 $8.95
For orders of 30+ call for lowest shipping.
Reminder Bead Kits  
Quantity Shipping
01—10  $4.95
11—25  $5.95
25—50  $7.95
51—100  $8.95
101—200  $10.95
For orders of 200+ call for lowest shipping rates.

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