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Courter Films and Associates Order Form
SPECIALIZING IN MEDIA ABOUT CHILDREN'S ISSUES AND STRENGTHENING FAMILIES
Please print this page, then complete IN FULL and mail or fax. Top portion of form will be used to prepare your shipping label so please PRINT or TYPE legibly.
BILLING INFORMATION: CONTACT NAME:_______________________________________________________ PHONE NO.:(______)__________________________ E-MAIL ADDRESS:_____________________@_______________________________ BUSINESS/ORGANIZATION NAME:_________________________________________ STREET ADDRESS:_____________________________________________________ CITY, STATE:________________________________________________________ ZIP or COUNTRY CODE:________________________________________________ SHIPPING INFORMATION: BUSINESS/ORGANIZATION NAME:_________________________________________ STREET ADDRESS:_____________________________________________________ CITY, STATE:________________________________________________________ ZIP or COUNTRY CODE:________________________________________________
METHOD OF PAYMENT: U.S. Funds Only
Credit Card #:_____________________________________Exp. Date:________
Name (if different than contact above):______________________________
Signature:___________________________________________________________
Check #__________ Approved Purchase Order #_______________________
Amount Enclosed $___________
We accept VISA and Mastercard or approved agency purchase order.
| Product |
Price |
x |
Quantity |
= |
$ TOTAL |
| CHILDREN'S SOCIAL SERVICES AND JUVENILE JUSTICE |
| "Permanency Toolkit: Family Group Decision Making" SS-05 |
$145.00 |
x |
. |
= |
$ |
| "Permanency Toolkit: Mediation" SS-06 |
$145.00 |
x |
. |
= |
$ |
| "Permanency Toolkit: Concurrent Case Planning" SS-07 |
$145.00 |
x |
. |
= |
$ |
| "A Plan for Joseph: An Actual Family Group Conference" SS-08 |
$165.00 |
x |
. |
= |
$ |
| SPECIAL! Purchase all three "Permanency Toolkit" videos together and save $40! PT-3ALL |
$395.00 |
x |
. |
= |
$ |
| SPECIAL! Purchase all three "Permanency Toolkit" videos + "A Plan for Joseph" and save $105! PTALL+J |
$495.00 |
x |
. |
= |
$ |
| "Where's My Chance? The Case for Our Children" SS-01 |
$39.95 |
x |
. |
= |
$ |
| "Special-Needs Adoption" 3, 2, & 1 minute. SS-02A |
$19.95 |
x |
. |
= |
$ |
| "Special-Needs Adoption" 5 minute service club version. SS-02ACL |
$19.95 |
x |
. |
= |
$ |
| "Child Advocacy and the National CASA Program" 3, 2, & 1 minute. SS-02B |
$19.95 |
x |
. |
= |
$ |
| "Child Advocacy and the National CASA Program" 4.5 minute service club version. SS-02BCL |
$19.95 |
x |
. |
= |
$ |
| "Community Partnerships and the Success by 6® Program" 3, 2, & 1 minute. SS-02C |
$19.95 |
x |
. |
= |
$ |
| "Community Partnerships and the Success by 6® Program" 5 minute service club version. SS02CCL |
$19.95 |
x |
. |
= |
$ |
| "Literacy and the Feed Me a Story® Program" 3, 2, & 1 minute. SS-02D |
$19.95 |
x |
. |
= |
$ |
| "Literacy and the Feed Me a Story® Program" 4 minute service club version. SS-02DCL |
$19.95 |
x |
. |
= |
$ |
| "Family Violence® Program" 3, 2, & 1 minute. SS-02E |
$19.95 |
x |
. |
= |
$ |
| "Mentoring® Program" 3, 2, & 1 minute. SS-02F |
$19.95 |
x |
. |
= |
$ |
| "Shaken Baby Syndrome® Program" 3, 2, & 1 minute. SS-02G |
$19.95 |
x |
. |
= |
$ |
| "Throw Away the Key?" SS-03 |
$29.95 |
x |
. |
= |
$ |
| "You Can Make the Difference" SS-04 |
$39.95 |
x |
. |
= |
$ |
| CHILDBIRTH EDUCATION |
| "Magical Moments of Birth" CE-01 |
$79.95 |
x |
. |
= |
$ |
| "Tender Loving Care: Parenting the Newborn" CE-02 |
$59.95 |
x |
. |
= |
$ |
| "Family Centered Cesareans" CE-03 |
$59.95 |
x |
. |
= |
$ |
| "Saturday's Children" CE-04 |
$69.95 |
x |
. |
= |
$ |
| "The Teenage Pregnancy Experience" CE-05 |
$49.95 |
x |
. |
= |
$ |
| "Caring & Coping: The New Parent Experience" CE-06 |
$49.95 |
x |
. |
= |
$ |
| ENVIRONMENT |
| "The Florida Water Story" EN-01 |
$24.95 |
x |
. |
= |
$ |
| "The Trouble With Manatees" EN-02 |
$19.95 |
x |
. |
= |
$ |
| "Our Magnificent Estuary" EN-03 |
$24.95 |
x |
. |
= |
$ |
| "Introduction to Our Magnificent Estuary" EN-04 |
$19.95 |
x |
. |
= |
$ |
| "The Mysterious Manatee" EN-05 |
$24.95 |
x |
. |
= |
$ |
| FIREFIGHTING |
| "Hazardous Materials - Incident Command" FF-01 |
$49.95 |
x |
. |
= |
$ |
| "Hazardous Materials - Protective Apparatus" FF-02 |
$49.95 |
x |
. |
= |
$ |
| "Hazardous Materials - Evacuation" FF-03 |
$49.95 |
x |
. |
= |
$ |
| SPECIAL! Entire series of three Firefighter training videos/FREE SHIPPING in continental US. FF-ALL |
$99.95 |
x |
. |
= |
$ |
| Shipping & Handling charges* (UPS Ground-Cont.US)** |
. |
| GRAND TOTAL |
$ |
* Shipping & Handling: 1 video = $9.95; 2-5 videos = $11.95; 6-10 videos = 13.95; larger orders get shipping quote. Free Shipping on orders of 25 or more copies.
**Charges shown are for shipping via UPS Ground within the Continental U.S. Call if other shipping method desired.
To place your order, print this page, then complete IN FULL and mail along with your Check or in US Funds. Top portion of form will be used to prepare your shipping label so please PRINT or TYPE legibly. If paying by credit card or approved purchase order please cut and paste form and E-MAIL to INFO@COURTERFILMS.COM or FAX form to 352-795-6144.
Please mail completed form with payment to:
Courter Films and Associates
121 NW Crystal Street
Crystal River, FL 34428
Make checks payable to: Courter Films and Associates
CALL 352-795-2156 TO PLACE YOUR ORDER BY PHONE
Thank you for your order.
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