WHEA Maint Plant Ops Recognition Order Form - Wisconsin Healthcare Engineering Association

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Today's Date*

Name:*

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Facility:*

Address*

Street Address City State Zip

Phone

Fax:

Email*

Commemorative Buttons, ea.

Price: $2.00

2 ft. x 6 ft. Vinyl Banner - Horizontal

Price: $100.00

2 ft. x 6 ft. Vinyl Banner - Vertical

Price: $100.00

12 in. x 18 in. Durable Poster, ea.

Price: $6.00

Delivery Plan*

Total

Payment Options:*

Check

Invoice/PO#

Credit Card

Invoice/PO#

Credit Card

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Expiration Date

Security Code Cardholder Name

When paying by check, send to: WHEA, PO Box 374, Woodruff, WI 54568. For questions contact: Jane Bruvold at info@whea.com.