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Printable Order Form
Call in your credit card orders to NCI at 1-800-345-6901, fax your orders to 1-727-367-7864 or e-mail your order using this form. All sales for shipment to Florida addresses are subject to Sales Tax.

Name
Address
City
State
Zip
*Shipping address if different from above
Address
City
State
Zip
Phone
Fax
E-Mail
Study Aids
Quantity
Item
Total
Publications
Quantity
Item
Total
Charting Tools
Quantity
Item
Total
*Shipping & Handling
Sub Total
If Florida Resident,
Add 7%
Total
Card Type
MasterCard
Discover
American Express
Visa
Number
Exp Date
Code #
*
*For Visa, Mastercard and Discover, the code number is a 3 digit number on the reverse side of your credit card, usually on the signature block, immediately after the last 4 numbers of your credit card account.
*Shipping & Handling
Merchandise Total: Regular Mail: Priority Mail
$0 - $39.99 $3.00 $6.00
$40 - $64.99 $5.00 $7.50
$65 & over $7.50 $10.00
Please call 800-345-6901
for Express Mail charges

 

Signature______________________________
(required on charges)

Print & Mail this form to:
National Captain's Institute
PO Box 11834
St. Petersburg, FL 33733
or Fax to (727) 367-7864,
or call us at (800) 345-6901

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