Client Order Form
To order materials described in our catalog, please provide the information requested below. If you should have questions, please contact (800) 233-1957 ext. 7680 or email .
Please Type or Print Legibly
Policy #:Organization Name: / Today’s Date: // / Need Materials ://
Also known as (Org Name): / Contact Name:
Shipping Address** (Use UPS Street Mailing Address Only–No P.O. Boxes): / Billing Address (If different than shipping):
**Check what type of address: RESIDENTIAL or BUSINESS
City: / State: / Zip: / County: / Web Address:
Daytime Telephone: () / Evening Telephone: () / E-Mail:
Item # / Description / Qty / Cost / Total
Emergency Vehicle Operations
C10:256 / Emergency Vehicle Driver Training Kit 2008 Edition / 1 NC*/$60
C10:258 / EVDT Participant Manual 2008 Edition / $3
C08:099 / Emergency Vehicle Response Safety (EVRS) Kit / 1 NC*/$45
C08:104 / EVRS Participant Manual / $3
C10:296 / Trailer Safety DVD / 1 NC*/$45
C10:015C / Dynamics of Emergency Vehicle Response (DEVR) Kit / 1 NC*/$45
C10:015 / DEVR Participant Manual / $3
C10:073A / ParaTransit Instructor Kit / 1 NC*/$45
C10:104 / Highway Safety Kit / 1 NC*/$45
C10:100 / Highway Safety Participant Manual / $3
C10:501 / UTV/ATV Safety CD / 1 NC*/$35
Risk Management
C10:139 / Risk Management for EMS Resource Guide / 1 NC*/$35
C10:293 / Understanding Aerial Device Testing CD / 1 NC*/$25
Management
C10:185 / Transforming The Volunteer Fire Service / 1 NC*/$10
C10:197 / Managing Volunteer & Combination Emergency Service Organizations: Tips for the Fire Dept. CEO (CD Only) / 1 NC*/$35
C10:291 / ESO Disaster Planning & Business Continuity CD / 1 NC*/$35
C10:245 / Harassment & Discrimination Prevention Training CD/DVD / 1 NC*/$45
C10:513 / Maintenance Tracking Software CD / 1 NC*/$25
*1 NC/$ means that if your organization has not already received a copy of that item, your organization can get one (1) copy at no cost. Additional copies are available to purchase for the amount listed.
Safety & Risk Management
C10:182 / Preventive Maintenance for Emergency Services DVD / 1 NC*/$35
C10:183 / Highway Safety for Emergency Services DVD / 1 NC*/$35
C10:189 / Intersection Safety DVD / 1 NC*/$35
C10:174 / Rollover Safety DVD / 1 NC*/$35
C10:190 / POV Safety DVD / 1 NC*/$35
C10:168 / Patient Handling DVD / 1 NC*/$35
C10:297 / Safe Backing Practices DVD / 1 NC*/$35
Health & Safety
C10:048 / Firefighter Safety Kit / 1 NC*/$45
C10:132 / Firefighter Safety Participant Manual / $3
EMS Operations
C10:044 / Patient Care Documentation Instructor Kit / 1 NC*/$45
C10:037 / Patient Care Documentation Participant Manual / $3
C10:071 / Medical Miranda Card Kit (25 Cards Included) / 1 NC*
C10:072 / Additional Medical Miranda Cards / Up to 100 NC*/$.75
C10:025 / Patient Handling Instructor Kit / 1 NC*/$60
C10:023 / Patient Handling Participant Manual / $3
Miscellaneous Materials
C08:033 / Liquor Liability Prevention Kit / 1 NC*/$3.50
C10:031 / Driver Accident Reporting Packet / 1 per vehicle NC*/$1.50
Item # / Description / Qty / Cost / Total
Safety Posters
C10:075 / Safety Poster Kit (One of each poster listed below) / 1 NC*/$25
C10:033 / Intersection Poster / $1.50
C10:034 / Working Together Poster / $1.50
C10:035 / Seat Belts Poster / $1.50
C10:036 / Avoid Backing Accidents Poster / $1.50
C10:052 / Deliver the Tank Poster / $1.50
C10:053 / Limitations Poster / $1.50
C10:054 / Proper Equipment Poster / $1.50
C10:055 / Building Blocks Poster / $1.50
C10:056 / Volunteer Poster / $1.50
C10:058 / Rollover Poster / $1.50
C10:059 / Off-Road Driving Poster / $1.50
C10:060 / Weight Limitations Poster / $1.50
C10:088 / Is the Scene Safe Poster / $1.50
C10:089 / Think Scene Safety Poster / $1.50
C10:092 / Driving POV’s Poster / $1.50
C10:097 / Bloodborne Pathogens Poster / $1.50
Item # / Description / Qty / Cost / Total
Safety Posters–Continued
C10:098 / Circle for Safety Poster / $1.50
C10:121 / Preventative Maintenance Poster / $1.50
C10:122 / Safe Following Distance Poster / $1.50
C10:264 / Patient Lifting / $1.50
C10:266 / Advance Warning / $1.50
C10:267 / A Good Leader / $1.50
C10:268 / Distractions / $1.50
C10:269 / Near Miss / $1.50
C10:270 / Driver Training / $1.50
C10:401 / Seated and Belted / $1.50
C10:402 / Know Your Limitations / $1.50
C10:403 / Don’t Overlook the Obvious / $1.50
C10:404 / Warning Devices / $1.50
C10:414 / Situational Awareness / $1.50
C10:415 / Flying Objects / $1.50
C10:416 / Good House Keeping / $1.50
C10:417 / Early Detection / $1.50
*1 NC/$ means that if your organization has not already received a copy of that item, your organization can get one (1) copy at no cost. Additional copies are available to purchase for the amount listed.
Sub Total: / Shipping & Handling: / Sub Total + S&H:Please add the appropriate Shipping & Handling charges to your order as listed below
$ Payment due in U.S. Dollars $
Order Total / ContinentalU.S. / AK, HI, Canada
Free–$5 / No Charge / No Charge
$5.01–$25 / $6 / $12
$25.01–$50 / $8 / $16
$50.01–$100 / $10 / $20
$100.01–$200 / $16 / $26
$200.01–$300 / $20 / $30
$300.01–$400 / $30 / $40
$400.01-$500 / $36 / $46
$500.01- $600 / $44 / $65
$600.01 & Up / $60 / $78
Revised 7/25/13
Form of PaymentPlease submit your order to:
VFIS, P.O. Box 2726, York, PA 17405
Fax to: (717) 747-7028, email to: ,
or order from our website at www.vfis.com.
Please check the appropriate box below:
Enclosed is a check made payable to VFIS
Enclosed is a Purchase Order # ______
(Sending a PO separately will cause a duplicate order)
Invoice me for the proper total amount
I authorize VFIS to charge my order to:
VISA MasterCard Discover
Print Cardholder’s Name:
Account #: / Exp.: / /
Signature of Actual Cardholder: