play safe! be safe!® Order Form                           biclogo.gif (2081 bytes)

To order your play safe! be safe!   kit, send:                                                 
                            U.S. orders $12 per kit for shipping/handling;
                            Canadian orders $19 per kit for shipping/handling.

Make checks payable to:
                            BIC Corporation
                            One Grove St., Suite 210
                            Pittsford, NY  14534
                            Telephone 585-385-3370, Fax 585-264-1754


Please provide the following contact information:

Name
Title
School or Center
Street Address
Address (cont.)
City
State/Province
Zip/PostalCode
Country
Telephone
Fax
Email
Website

LOCATION

PRODUCT

QUANTITY SHIPPING & HANDLING TOTAL DUE

BILLING INFORMATION

U.S. ORDERS English Kit x   $12.00

P.O. Number:

French Kit x   $12.00

CANADIAN ORDERS

English Kit x  $19.00

Check Enclosed:

French Kit x  $19.00

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