KID I.D. CARD --- ORDER FORM

KID I.D. CARD
ORDER FORM^*

CHECK APPROPRIATE LINE:
KID I.D. CARD _____ TEEN I.D. CARD _____
Please fill out all information, type or print clearly. Put n/a in information fields you wish to omit.

NAME: _________________________________________________________

ADDRESS:_______________________________________________________

CITY, STATE, ZIP: _________________________________________________

SEX: _____ HEIGHT: _____ WEIGHT: _____ EYES: _____ SOCIAL SECURITY: _________________________

ISSUE DATE: __________ DOB: ______________ ALLERGIES: __________________________

SPECIAL CONDITIONS: ____________________________________________

PRIMARY CONTACT: ___________________________ HOME PH#: _______________ WORK PH#: __________
SECONDARY CONTACT: _________________________ HOME PH#: _______________ WORK PH#: __________
ALTERNATE CONTACT: _________________________ HOME PH#: _______________ WORK PH#: __________

PRODUCT	PRICE	AMOUNT
I.D. CARD	$10.00 EA.	_________
SAFETY LANYARD / PLASTIC HOLDER	$3.00 EA.	_________
NECK LANYARD / PLASTIC HOLDER	$2.00 EA.	_________
NECK CHAIN / PLASTIC HOLDER	$2.00 EA.	_________
BADGE HOLDER / CLIP	$1.00 EA.	_________
	SUBTOTAL	_________
BATON ROUGE RESIDENTS ADD SALES TAX	8%	_________
LOUISIANA STATE RESIDENTS ADD SALES TAX	4%	_________
SHIPPING & HANDLING		__$2.00___
	TOTAL	_________

^*PRINT OR DOWNLOAD FORM FOR EACH ORDER
SEND A CHECK OR MONEY ORDER FOR TOTAL AMOUNT OF ALL ORDERS TO:

KID I.D. CARD INT’L
824 NORTH 7^th STREET
BATON ROUGE, LA. 70802
504-387-2484
www.kididcard.com

PLEASE ALLOW 2-4 WEEKS TO RECEIVE YOUR ORDER
WE RECOMMEND UPDATE EVERY TWO YEARS

EMAIL YOUR QUESTIONS OR COMMENTS TO: kididcard@aol.com

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