School District:

School:

Changes

Teacher:

Month & Year kit will be taught:

Fill in your order on the computer screen (TAB key moves the curser), SAVE the completed order on your computer and ATTACH the saved order to an e-mail addressed to: . Important: Do not save the form for future use. Use a fresh download from the SEPARSI web site each time you submit a new order. WARNING: small parts are a choking hazard. Adult supervision is required. See SEPARSI web page. Form: 2012-13

*SDur / *Con / (*Sdur=Semi-Durable item; *Con=Consumable item; *This number is given here only to indicate the quantity of items in a new kit for 30 students. Do not use this number as a multiplier for ordering items.) / Order: / Unit / ID / Prices / Filled
1 / Bag, plastic zip lock, snack bag pk 50 / pack / 1819 / 6.90
1 / Band, rubber #14 pk 25 / pack / 1833 / .97
2 / Card, index, 3x5 pk 100 / pack / 1640 / 2.07
60 / Cup, 1 oz, plastic / each / 1917 / .06
100 / Cup, 9 oz, plastic / each / 1170 / .14
30 / Cup, 4 oz, plastic (order lid below) (must fit inside the 9-oz cup) / each / 1228 / .08
9 / Dish, petri, large, 5 inch / each / 1821 / .55
1 / Envelope, #6 pk 15 / pack / 1857 / 1.04
1 / Fabric, mesh square 6" pk 15 / pack / 1614 / 8.21
2 / Filter, paper, coffee, large pk 50 / pack / 1841 / 4.07
1 / Gravel, aqua 5-lb / each / 1156 / 4.14
1 / Juice, lime, pint / each / 1861 / 5.52
45 / Lid, cup, plastic 1 oz / each / 1441 / .55
30 / Lid, cup, plastic 4 oz / each / 1229 / .55
45 / Lid, cup, plastic 9 oz / each / 1171 / .55
1 / Paper, const, black 9x12 pk 50 / pack / 1266 / 3.45
1 / Paper, const, orange (cut into quarters) pk of 16 quarters / pack / 1835 / 1.31
1 / Paper, toilet, individual sheets pk 15 / pack / 1837 / 1.04
1 / Pepper, black 1 oz. / each / 1849 / 2.35
1 / Powder, baking, double-acting 4-oz / each / 1859 / 3.45
1 / Salt, kosher 3 lb box / each / 2512 / 5.52
1 / Soda, baking 1 lb / each / 1853 / 2.76
1 / Steel wool, pad, fine pk 16 / pack / 1855 / 8.97
1 / Stirrer, wood, coffee pk 250 / pack / 1319 / 2.69
1 / Sugar, cube pk 17 / pack / 1845 / 1.31
1 / Sugar, granulated 10-oz / each / 1843 / 1.65
1 / Tablet, effervescent pk 54 / pack / 1813 / 15.18
1 / Tray, paper pk 15 / pack / 1607 / 7.18
1 / Vinegar, white 1 gal / each / 2765 / 7.59
Book, Kids Discover: Changes, pk 8 / pack / SD1898 / 54.65
Book, Literacy, Changes, pk 8 / pack / SD1896 / 120.89
16 / Bottle, dropper / each / SD2713 / 4.83
2 / Bottle, insulated, qt thermos / each / SD1829 / 11.73
1 / Fastener, paper, brass bx 100 / pack / SD2654 / 4.07
16 / Forceps / each / SD2735 / .55
15 / Funnel, plastic, large (5 inch) / each / SD2806 / 4.07
30 / Lens, hand / each / SD1111 / 1.31
1 / Marker, China, any color / each / SD1823 / 1.73
8 / Marker, water-soluble, broad nib, black / each / SD1825 / 2.07
1 / Marker, fine-point, black, permanent / each / SD2572 / 2.07
8 / Marker, water-soluble, broad nib, green / each / SD1827 / 2.07
15 / Spoon, measuring, 1/2 teaspoon (2.5 ml) / each / SD1831 / 2.07
2 / Tray, ice cube / each / SD1816 / 2.42

Warehouse: Order picked by______Date______Order checked by______Date______