| Brain Injury Association of Mississippi | |||||
| Order Form | |||||
| - Please Print the form, fill out and mail with full payment - | |||||
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The Headie Hurtle Program Safety Program For Children is a delightful way for youngsters to be introduced to the importance of safe play habits. Whether biking, roller blading, playing sports or even on the bus to school, Headie leads children down the path of - PREVENTION - the one sure cure for TBI. Headie's Big Day and Headie Boards the Bus are story/coloring books. Accessories include safety stickers, billfold cards, Program Guides, and posters. Return BIA of MS Home Page |
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| Product | Unit Price | x | Quantity | = | Total |
| Program Guide | $2.00 | x | ___________ | = | ___________ |
| Posters | |||||
| Helmet Safety | $ .50 | x | ___________ | = | ___________ |
| Bus Safety | $ .50 | x | ___________ | = | ___________ |
| Coloring Books | |||||
| Headie's Big Day | $1.00 | x | ___________ | = | ___________ |
| Headie Boards the Bus | $1.00 | x | ___________ | = | ___________ |
| Helmet Safety Billfold Card | |||||
| each | $ .15 | x | ___________ | = | ___________ |
| Roll of 25 | $2.75 | x | ___________ | = | ___________ |
| Roll of 100 | $9.00 | x | ___________ | = | ___________ |
| Roll of 500 | $40.00 | x | ___________ | = | ___________ |
| Subtotal | ___________ | ||||
| Orders over $100.00 10% discount | - | ___________ | |||
| Shipping & Handling: | |||||
| $1.00 to $10.00 Add | $2.50 | + | ___________ | ||
| $11.00 to $30.00 Add | $4.00 | + | ___________ | ||
| $31.00 to $60.00 Add | $5.00 | + | ___________ | ||
| $61.00 to $100.00 Add | $8.00 | + | ___________ | ||
| $101.00 to $150.00 Add | $12.00 | + | ___________ | ||
| Over $150.00 Please call | ___________ | ||||
| Total Amount Enclosed | = | ___________ | |||
| Please make Checks Payable to: | |||||
| The Brain Injury Association of Mississippi | |||||
| Our address: | |||||
| P.O. Box 55912 - 2727 Old Canton Road | |||||
| Jackson, MS 39296 | |||||
| Phone (601) 981-1021 | |||||