ITRE / HWY / Products / Work Zone Safety Materials Order Form

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Work Zone Safety Training Materials Order Form
(Price changes are effective July 1, 2006, Tax changes were made to this form December 8, 2006)

NC State University." Municipalities, utilities, and contractors may use this form to order training materials. Please complete all requested information and review your order. Then, submit your order using one of the methods described at the end of this form.

Quantity	Title	Unit Cost	Total Cost (form enters cost automatically)
	Work Zone Safety Video: "Work Zone Safety for Roadway Maintenance Operations"	$15.00
	Work Zone Safety Pocket Guide: (2002 version, 44 pages) "Guidelines for Construction, Maintenance and Utility Operations"	$4.00
	Basic Work Zone Safety Instructor's Kit: Includes Instructor's Guide, Work Zone Safety Videotape, and Work Zone Safety Pocket Guide.	$45.00
	Intermediate Work Zone Safety Guidelines: Includes Multiple Lane Closures, Intersections, Detours, Inspections, and Part VI of MUTCD.	$32.50
	Advanced Work Zone Safety Guidelines: Includes Planning, Capacity, Technology, and Use of Standard Drawings.	$15.00
	Model Road Plan Sheets (2 blueline copies per set.)	$5.00
	Manual on Uniform Traffic Control Devices (MUTCD) – Parts I, V, and VI. (2004 Edition)	$18.00
	Flagging Video: "Flagging Operations and Procedures."	$15.00
	Flagger's Handbook (English).	$1.50
	Flagger's Handbook (Spanish).	$1.50
	Flagging Instructor's Kit: Includes Instructor's Guide, "Flagging Operations and Procedures" Videotape, and Flagger's Handbook.	$35.00
Orders less than $50.00 must be prepaid by check or money order.		SUBTOTAL	$

	North Carolina tax exempt companies or agencies must include tax exempt forms with each order. Orders from outside NC are not charged NC Sales Tax.	NC Only 6.75% Sales Tax	(form enters cost automatically) $
check this box if you are not placing an order within NC or are exempt.		NC Only 6.75% Sales Tax	(form enters cost automatically) $

(form enter quantity automatically)	Quantity Total	TOTAL	(form enters cost automatically) $
Note: The MUTCD Millennium Edition is available only on the MUTCD Web or through the Federal Highways Administration (FHWA) and America Traffic Safety Services Association (ATSSA).

BILL TO: * = required fields
* Name:
* Organization:
* Address:
* City:
* State:
* Zip Code:
* Phone Number:
* FAX number:
* E-mail address:

SHIP TO:	Same as "BILL TO" Address
Note: We cannot ship to Post Office (PO) Boxes.
Name:
Organization:
Address:
City:
State:
Zip Code:
Phone Number:
FAX number:
E-mail address:

Remittance Enclosed (payable to: North Carolina State University)

Purchase Order (PO) Number* (enter PO number)
If there are TERMS and CONDITIONS with the PO, you MUST provide them before the order can be processed.
Please FAX to Christie Vann: 919-515-8897.

My order is more than $50. Please bill me.

Enter today's date

If your order totals
LESS than $50

You must prepay by check or money order, payable to: North Carolina State University.

Print this form and mail it to the address shown below, along with your payment.

To print your completed form, use your browser's File > Print function.

Submit orders by mail to:
ATTN: Christie Vann
ITRE
NCSU Centennial Campus
Box 8601
Raleigh, NC 27695-8601

Thank you for your order. Please direct questions to
Christie Vann
919-515-8767

If your order totals
MORE than $50

Prepayment is not required. If you choose to prepay:

Print this form and mail it to the address shown at left, along with your payment.

To be billed:
FAX this form to:
Christie Vann
ITRE
919-515-8897

To be billed:
Press the submit button to send your request online.

last updated: 1/31/08

Work Zone Safety Training Materials Order Form (Price changes are effective July 1, 2006, Tax changes were made to this form December 8, 2006)

Work Zone Safety Training Materials Order Form
(Price changes are effective July 1, 2006, Tax changes were made to this form December 8, 2006)