Order Form

lalogotransp1.gif (3045 bytes) Means Breastfeeding Support!™1971-2008

ORDER FORM
1. Print this Order Form.
2. Browse our Catalog to see items & Prices 3. Submit your order by phone, fax or mail.

    See Ordering Instructions below

   Toll-Free Ordering
         1.866.866.1239
       Callers outside USA
              1.423.744.9090
    FAX 1.423.744.9116

Item Number	Description	PRICE	QTY	AMOUNT







__ I'm ordering a Cooler. If my 1st Choice above is not available, my 2nd Choice color is:		ORDER TOTAL		$
ONLY Tennessee residents add sales tax on Order Total.		Tenn. Sales Tax 7%		$
Every order includes Handling Fee of $4.75		Handling Fee		$ 4.75
Ship Via:		Shipping Fee		$
Ship Via:		GRAND TOTAL		$

Handling & Shipping Rates Chart
Handling Fee	UPS Ground	UPS 3-Day Select	UPS 2-Day Air	UPS 1-Day Air
$ 4.75	FREE !	$6.00	$8.50	$21.00

Handling Fee of $4.75 per order is already filled in for you on the Order Form.
Find the shipping service you want, UPS Ground, UPS 3-Day Select, etc., Add it to your Order.
Your Grand Total will include: Items Ordered, + Handling, + Shipping.

Shipping Rates are for USA .
Free UPS Ground Service.: Estimated Delivery Time 1- 2 days Tn &adjacent states. 3-4 days Eastern, Central & Mountain states.
5-6 days West Coast States. Allow extra days for weekends or holidays.
Shipping via US Mail: For Priority Mail Insured add $7.00 (3-day delivery). For Express Mail Insured add $19.50 (2-day delivery).: Note: Alaska, Hawaii, Puerto Rico: Shipped via US MAIL only.
RUSH Orders: If you need UPS 1- or 2-Day Air or 3-day Select, phone or FAX your order to expedite shipping.
Confirmation & UPS Tracking: Include your e-mail to receive confirmation & UPS Tracking Number.
International Orders: We ship worldwide. Request an Estimate of International Shipping Rates before ordering.

Returns/Refunds Policies:
Only unopened LA Systems and supplies are returnable for a refund, less 20% restocking fee.
Returns must be made within 30 days after purchase. Ship/Handling Fees are not refundable.
Only unopened LA Systems and supplies are returnable for a refund, less 20% restocking fee.
Returns must be made within 30 days after purchase. Ship/Handling Fees are not refundable.

Credit Card Billing Address & Payment Information:
Payment Method: Check one. __ Credit Card __ I'll phone Credit Card __Credit Card is on file __Check/Money Order enclosed
Credit Card: __ VISA __ MASTERCARD __ DISCOVER __ AMERICAN EXPRESS Verification code:_________
Card No.:		Expiration Date:
Signature:		Phone Home
Name		Phone Eve or Work
Address		.
Address		.
City:	State:	Zip Code:
NOTE: Address above should match your Credit Card Billing Address, If credit card address above is a PO Box or rural route, provide street address here for Credi Card Verification..
Email Include your e-mail to receive confirmation & UPS Tracking Number.

Shipping Information: if different from Credit Card Address / Payment Information.
Ship to: A Street Address is required for UPS delivery	Phone
Name	.
Street	.
City:	State
Zip Code:	State

Survey: Please check all that apply. This will help us improve our services.
I heard about Lact-Aid System from:			My breastfeeding situation is:
O Article O Lact. Consultant O Midwife	O Doctor O Nurse O Friend	O Book O WWW search O Email List	O Slow Wt. Gain O Low milk supply O Suck Problem	O Premie O Cleft Lip / Palate O Breast Surgery	O Working. O Relactation O Adopt O Surrogacy
O Other			O Other

To Top of Order Form

Ordering Instructions

Print this Order Form.
Browse our Catalog to select items & see Prices. Fill out Items section
Complete filling out Order Form. Fill out Credit Card/Payment Section.. Fill out Shipping Section.,
Submit your order: Use it for reference to phone your order. Order Toll-Free in USA.
or .... Fax or mail pages 1 and 2 to Lact-Aid. See phone numbers and addresses below.
Email Orders: You may email an order to us if your card information is ALREADY ON FILE at Lact-Aid. Or,
if you prefer, you may email an order to us, then phone or fax the credit card data to us. We do not recommend emailing credit card information yet as we are not set up for secure online transactions. On your email message, describe the items and quantity you want and method to ship.
Always include a daytime phone number in case we have questions about your order.
RUSH Service: If you need your order sent via UPS 1-day AIR, UPS 2-day Air, or UPS 3-Day Select ... we recommend phoning your order to expedite processing. See Order Form for rates and estimated delivery times.
International Orders - For orders outside the USA, see our International Orders Page and request an Estimate of International Shipping before ordering.

1.866.866.1239 Toll-Free Ordering in USA.
1.423.744.9090 Info & Consulting. Orders outside USA.
Lact-Aid International, Inc. PO Box 1066, Athens TN 37371-1066 USA
Send email to: orders@lact-aid.com

FAX 1.423.744.9116