CBA
ONLINE
ONSITE
 SPECIAL

by FAX only up to TWO WEEKS from the date of the class (print this page then fax to 866.211.4324)

_____________        _____________
CLASS DATE           Today's DATE
 
___________________________    ________________ Student Name                                 NORMI ID Number

 _____________________________________________ Shipping Address with City, ST, ZIP

____________________        ____________________ Telephone Number                           eMail Address

SystemSure II PLUS
ATP Luminometer

100 Pack Snap-It Swabs

(Shipping is Extra)

Regular RETAIL Price $1365.00
Special CBA Price $1159.00
Discounted for ONLINE ONLY