ORDER FORM
Please mail the completed form, with your payment to:
Proficient Procedures, Inc.
1654 Watson Boulevard
Warner Robins, GA  31093

Item Price Quantity Amount
DVD - All 5 Procedures on 1 DVD in a jewel case $99.95 ______ ___________
CD - SET of 5 Procedure CDs $99.95 ______ ___________
CD - Paracentesis and Thoracentesis (35 mins) $29.95 ______ ___________
CD - Bone Marrow Aspiration/Biopsy (15 mins) $29.95 ______ ___________
CD - Central Venous Catheterization (15 mins) $29.95 ______ ___________
CD - Arthocentesis (15 mins) $29.95 ______ ___________
CD - Lumbar Puncture (15 mins) $29.95 ______ ___________
VHS - SET of 5 Tapes $299.95 ______ ___________
VHS - 2nd SET of 5 Tapes $199.95 ______ ___________
VHS - Bone Marrow Aspiration/Biopsy (15 mins) $74.99 ______ ___________
VHS - Paracentesis and Thoracentesis (35 mins) $74.99 ______ ___________
VHS - Arthocentesis (15 mins) $74.99 ______ ___________
VHS - Central Venous Catheterization (15 mins) $74.99 ______ ___________
VHS - Lumbar Puncture (15 mins) $74.99 ______ ___________
SUBTOTAL ___________
Sales Tax (GA Residents please add 7%) ___________
Shipping/Handling Please add 30% for US Orders,
35% for International Orders.
___________
TOTAL ___________

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Address: ___________________________________________________
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Phone Number: ______________________
Email Address: ________________________________
How did you hear about Proficient Procedures? _____________________________________
Payment Method:    Cashier's Check Money Order