First Aid Supplies Order Form

First Aid Supplies Order Form

FORM-018
Current client *

Yes No
Contact name *
Email address *

Confirmation Email please confirm your email address
Mobile *
Method of collection - please note for same day collection this form must be completed prior to 2pm *

Pick up Postage - charges apply
Postage charges vary dependant on the order size. Postage charges will be added to invoice based on Australia Post fees and charges. Pick up is recommended where ever possible.
Date *

Day Month Year
Date
at
Hour Minutes AM/PM Option Date Picker Icon
Unit / Flat / Suite / Apartment details
Building / Property name
Street or lot number (eg. 205 or Lot 118) *
Street name *
Suburb | Locality | Town *
What is your postal address (if different from above)?

Add postal address
Unit / Flat / Suite / Apartment details
Building / Property name
Street or lot number (eg. 205 or Lot 118)
Postal delivery information (eg PO Box 254)
Street name
Suburb | Locality | Town
Bill to employer

Yes No
Organisation name *
Trading name
Contact name *
Full name
Email address *

Confirmation Email please confirm your email address
Choose the item(s) you would like to purchase below and enter the amount of units for each;
Sharps container (FA1809)
First Aid FAST booklet (FA1808)
E-Chamber spacer (FA1805)
Re-usable hot & cold pack (FA1806)
FLEX splint material (FA1807)
CPR keyring mask (FA1810)
CPR pocket mask + orange case (FA1803)
Saline steri-tube 15ml (FA1804)
Envelope home first aid kit (FA1802)
Vehicle First Aid Kit (FA1801)
AED - Automated External Defibrillator (FA1812)

About the product:

The A15 eliminates the need for 2 sets of pads.With the flick of a switch and one set of pads you can change the function setting from Adult to Child. Less ongoing pad replacement costs.

Saves precious time in an emergency.

Package Includes:
- HeartOn A15 Defibrillator
- 5 Year Lithium Battery
- 5 Year Warranty
- Set of Adult/Child Pads
- Casualty Prep Kit
- Carry bag with shoulder strap
- AED Location Sign
- CPR Wall Sign, with QR Code videos
- CPR & Defibrillation learner guide
AED - Automated External Defibrillator (FA1812)
Total order amount payable inc GST (excluding postage if required)
Payment method *
Signature *
Date and Time of signing *

Day Month Year
Date
at
Hour Minutes AM/PM Option Date Picker Icon
Version 18.1.0 / 14 August 2018 | Uncontrolled when printed

All Rights Reserved © KARBEN Training Solutions

KARBEN Training Solutions | Registered Training Organisation (RTO) | National RTO ID 91167

Email: info@kts.edu.au | Website: www.kts.edu.au | Phone: 02 4353 7188 | Postal Address: Po Box 3380 Tuggerah NSW 2259
OFFICE USE ONLY
Date order form received

Day Month Year
Date Date Picker Icon
Stock availability confirmed

Available Not available
Details of order; stock required, stock ordered, etc
Postage to be charged
Invoice date

Day Month Year
Date Date Picker Icon
Invoice #
Payment date

Day Month Year
Date Date Picker Icon
Items allocated

Day Month Year
Date Date Picker Icon
Last Edit date & time *
Form status *

Open Closed
Version 18.1.0 / 14 August 2018 | Uncontrolled when printed

All Rights Reserved © KARBEN Training Solutions

KARBEN Training Solutions | Registered Training Organisation (RTO) | National RTO ID 91167

Email: info@kts.edu.au | Website: www.kts.edu.au | Phone: 02 4353 7188 | Postal Address: Po Box 3380 Tuggerah NSW 2259
Should be Empty:

First Aid Supplies Order Form

OFFICE USE ONLY