ORDER YOUR INSPECTION SUPPLIES
VIRGINIA AUTOMATED SAFETY INSPECTIONS
PO Box 5407
Richmond, VA 23220-0407
(804) 359-3579
(877) 917-7888 Virginia Tech Support
DESCRIPTION
PACKAGES
PINK INSPECTIONS FORMS
Pks (250 Sheets/Pk)
QUANTITY DISCOUNTS
PAPER (250 Sheets/Pack)
1-4 Packs
$20.00 ea
5-9 Packs
$17.50 ea
10 or More
$15.00 ea
SHIPPING CHARGES
1-4 Packs
$10.00
5-9 Packs
$15.00
10 or More
$25.00
WHITE REPORT FORMS (8/SHEET)
Pks (250 Sheets/Pk)
PINK REJECTION FORMS (8/SHEET)
Pks (250 Sheets/Pk)
TOTAL FOR PAPER
(
Pks)
TAX
SUBTOTAL
SHIPPING
GRAND TOTAL
BILL TO:
Station ID
Facility Name
Your Name
Address
City
ST
Zip
Phone
eMail
Order Date
Comments
I authorize VASI/VADA to charge the credit card indicated in this web form, for noted amount on today’s date. This payment is for Inspection Supplies. I understand that returns, refunds and cancellations are {insert your policy here}. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card compan, so long as the amount corresponds to the terms indicated in this web form.
VIRGINIA AUTOMATED SAFETY INSPECTIONS