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KPTA. com RESTORATIVE AIDE TRAINING MANUAL ORDER FORM Billing Information Company Name Address Telephone Contact City State Zip Code Fax E-Mail Shipping Address if different from above Company Methods of ordering Telephone 785 233-5400 Fax 785 290-0476 Mail KPTA 2900 SW Plass Ct Ste 202 Topeka KS 66611 Please send manuals 43. Kansas Physical Therapy Association 2900 SW Plass Ct Ste 202 Topeka KS 66611 Phone 785 233-5400 Fax 785 290-0476 Email kpta kpta*com www. 00 each. Shipping and handling fees 1-4 Books 8. 00 5-9 Books 12. 00 10-20 Books 20. 00 21-30 Books 28. 00 31 Books 36. 00 P. O. TOTAL DUE Payment Info I authorize KPTA to bill my credit card for payment of the above item s. Credit Card Exp* Date CVV Name of Cardholder as it appears on card Check Enclosed Bill Me Return Policy Restorative Aide Training Manuals may be returned minus shipping and handling fees. All manuals must be unused and in perfect condition* A re-shelving charge equal to 10 of the order will be accessed on all returns. KPTA will not be responsible for shipping charges to return the manuals to the KPTA office. Please contact the KPTA office for return authorization within 60 days of purchase. 00 each. Shipping and handling fees 1-4 Books 8. 00 5-9 Books 12. 00 10-20 Books 20. 00 21-30 Books 28. 00 31 Books 36. 00 P. O. TOTAL DUE Payment Info I authorize KPTA to bill my credit card for payment of the above item s. 00 31 Books 36. 00 P. O. TOTAL DUE Payment Info I authorize KPTA to bill my credit card for payment of the above item s. Credit Card Exp* Date CVV Name of Cardholder as it appears on card Check Enclosed Bill Me Return Policy Restorative Aide Training Manuals may be returned minus shipping and handling fees. Credit Card Exp* Date CVV Name of Cardholder as it appears on card Check Enclosed Bill Me Return Policy Restorative Aide Training Manuals may be returned minus shipping and handling fees. All manuals must be unused and in perfect condition* A re-shelving charge equal to 10 of the order will be accessed on all returns. All manuals must be unused and in perfect condition* A re-shelving charge equal to 10 of the order will be accessed on all returns. KPTA will not be responsible for shipping charges to return the manuals to the KPTA office. Please contact the KPTA office for return authorization within 60 days of purchase. 00 each. Shipping and handling fees 1-4 Books 8. 00 5-9 Books 12. 00 10-20 Books 20. 00 21-30 Books 28. 00 31 Books 36. 00 P. O. TOTAL DUE Payment Info I authorize KPTA to bill my credit card for payment of the above item s. Credit Card Exp* Date CVV Name of Cardholder as it appears on card Check Enclosed Bill Me Return Policy Restorative Aide Training Manuals may be returned minus shipping and handling fees. 00 31 Books 36. 00 P. O. TOTAL DUE Payment Info I authorize KPTA to bill my credit card for payment of the above item s. Credit Card Exp* Date CVV Name of Cardholder as it appears on card Check Enclosed Bill Me Return Policy Restorative Aide Training Manuals may be returned minus shipping and handling fees. All manuals must be unused and in perfect condition* A re-shelving charge equal to 10 of the order will be accessed on all returns.

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