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Purchase CAAS Products
CAAS offers a variety of products for those entering the Accreditation process as well as those agencies that have earned Accreditation and want to proudly display it.
Print this page, fill in the information requested, and then fax it to CAAS Orders: (847) 657-6825
Or mail this form with Credit Card info or Check to:
CAAS
Attn: Karen Charewicz
1926 Waukegan Road, Suite 1
Glenview, IL 60025-1770
CAAS Products Order Form
| Name:________________________________________________ |
| Title:_________________________________________________ |
| Organization:__________________________________________ |
| Mailing Address:________________________________________ |
| Street Address:________________________________________ |
| City:_________________________________________________ |
| State:________________________________________________ |
| Zip:_________ |
| Country:______________________________________________ |
| Phone Number:______________________ |
| Fax:_______________________________ |
| Email:______________________________ |
| Provider Type: (please circle response) County Fire Dept. Hospital Municipal Police Private Public Service Public Trust Third Service Public Utility Model |
| Total # of medical transports per year:_________ |
| Quantity | Item Description | Unit Cost | Total Cost |
| _______ | CAAS Standards (version 2.5) | $25.00 | _________ |
| _______ | Application Package (version 2.5) | $100.00 | _________ |
| _______ | Large Date Strips | $1.50 | _________ |
| _______ | Small Date Strips | $1.50 | _________ |
| _______ | "ACCREDITED" Lapel Pin | $4.00 | _________ |
| _______ | "ACCREDITED" Vehicle Stickers 6" diameter | $2.50 | _________ |
| _______ | "ACCREDITED" Vehicle Stickers 8" diameter | $3.50 | _________ |
| _______ | "ACCREDITED" Vehicle Stickers 12" diameter | $5.50 | _________ |
| _______ | Stationery Seal (1 1/2"diameter gold CAAS logo) | $.50 | _________ |
| _______ | Certificate Seal (2" diameter gold CAAS logo) | $.60 | _________ |
| _______ | Accreditation Certificate | $10.00 | _________ |
| _______ | Bronze Accreditation Plaque | $180.00 | _________ |
| Grand Total | |||
Credit Card Information:
| Select Credit Card:________________________________ |
| Card Number:____________________________________ |
| Expiration Date:__________________________________ |
| Name on Card:___________________________________ |
Questions? Contact Karen Charewicz at (847) 657-6828 or at karenc@tcag.com
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