Supplies Order Form - Utah Trucking Association

UTAH TRUCKING ASSOCIATION
4181 W. 2100 S.
WEST VALLEY CITY, UT 84120
801- 973-9370 FAX 801- 973-8515
ORDER FORM
SAFETY& REGULATORY FORMS
Description
Member
Non-Member
Accident Reporting Kit
Accident Reporting Register
$ 4.00
$ 13.00
$ 5.00
$ 15.00
Driver File(s) 1 – 4 (47-F)
Driver Files(s) 5 – 9 (47-F)
Driver File(s) 10 + (47-F)
$ 6.00 ea
$ 5.50 ea
$ 5.00 ea
$ 7.00 ea
$ 6.50 ea
$ 6.00 ea
Driver Investigation History File (860-FP)
$ 4.00 ea
$ 5.00 ea
Driver Confidential/History File (2 in 1) (856-FP)
$ 7.50 ea
$ 8.50 ea
All-in-One Confidential File (RW 47-FP)
$ 13.50 ea
$ 15.50 ea
Driver Application (White paper)
Driver Application (Manila Folder)
$ .90 ea
$ 1.10 ea
$ 1.35 ea
$ 1.55 ea
DRIVER LOG BOOKS
Logbook/Duplicate Simplified Recap (CPB L) 1-99
Logbook/Duplicate Simplified Recap (CPB L) 100+
$ 1.30 ea
$ 98.00 case
$ 1.50 ea
$135.00 case
Logbook/Duplicate 24 Hr Recap (601LD) 1-99
Logbook/Duplicate 24 Hr Recap (601LD) 100+
$ 1.85 ea
$ 155.00 case
$ 2.20 ea
$ 195.00 case
Logbook/Duplicate Exemption Driver (691-L)
100 air-mile radius driver
$
2.00 ea
$
Monthly Log Envelope (6x9) (695-F)
Trip Cost Report Envelope (29-F)
$
$
.75 ea
.85 ea
$ 1.00 ea
$ 1.30 ea
2.35 ea
FEDERAL REGULATION BOOKS
FMCSR MANAGEMENT Edition
FMCSR Driver POCKET Edition
$ 12.00 ea
$ 5.00 ea
$ 15.00 ea
$ 7.00 ea
HAZARDOUS MATERIALS REGULATIONS & FORMS
49 CFR Parts 100-199 (Softbound)
2012 Emergency Response Guidebook
Handling Hazardous Material (370-H)
Hazardous Material Compliance Pocketbook
(121-ORS)
Placards (Removable Adhesive)
DOT Chart 14
* PRE-payment required for special orders
$ 35.00 ea
$ 5.00 ea
$ 20.00 ea
$ 45.00 ea
$ 6.00 ea
$ 25.00 ea
$ 6.00 ea
$ 1.10 ea
$ 1.00 ea
$ 7.00 ea
$ 1.35 ea
$ 1.50 ea
Quantity
Total
VEHICLE INSPECTION & MAINTENANCE
Description
Member
Non-Member
Vehicle Inspection Report (NCR /CPB D) 1-100
Vehicle Inspection Report (NCR /CPB D) 100 +
Vehicle Inspection Report – Straight Truck
$
$
$
2.35 ea
2.00 ea
2.35 ea
$
$
$
Maintenance File Folder (VMF 99)
Maintenance File Folder (ATA – VMRS 2000)
ATA Cargo Securement Guideline Book
$ 1.00 ea
$ 1.10 ea
$ 25.00 ea
$ 1.35 ea
$ 1.45 ea
$ 30.00 ea
Annual Inspection Report Form w/decal
CVSA Out-of-Service Criteria Handbook
$
.60 ea
$ 35.00 ea
$
.95 ea
$ 45.00 ea
POSTAGE & HANDLING COSTS
LOG BOOKS – ADD $18.00 PER CASE OF 100
VEHICLE INSPECTIONS - $20.00 PER CASE OF 100
OTHER SUPPLIES
$0 - $10.00
$10.01 - $20.00
$20.01 - $40.00
ADD $8.00
ADD $10.00
ADD $12.00
$40.01 - $50.00
$50.01 - $100.00
$100.01 – OVER
Quantity
Total
2.85 ea
2.55 ea
2.95 ea
TOTAL
ADD $14.00
ADD $16.00
ADD $19.00
MOST ORDERS SHIPPED WITHIN 24 HOURS
$
*TAX 6.85 %
$
SUBTOTAL
$
**SHIPPING
$
GRAND TOTAL $
MAIL OR FAX ORDER TO:
UTAH TRUCKING ASSOCIATION
4181 W. 2100 S.
SALT LAKE CITY UT 84120
[801] 973-9370 FAX [801] 973-8515
EMAIL: [email protected]
DATE______________________
COMPANY____________________________________________________________________________
ATTN________________________________________________________________________________
PHYSICAL ADDRESS_____________________________________________________________________
CITY____________________________________ STATE______________________ ZIP______________
PHONE__________________________________ EXT._______ FAX______________________________
*TAX EXEMPT SALES – PLEASE PROVIDE TAX EXEMPT NUMBER_________________ STATE/GOV.__________
PAYMENT OPTIONS
________ NON-MEMBER (PAYMENT REQUIRED WITH ORDER)
________ BILL ME (UTA MEMBERS ONLY) PO#_________________________________________________
 VISA  MASTERCARD  AMERICAN EXPRESS NUMBER________________________________________
Expires ______/______ Customer Code ________Authorization by________________________________________________
Prices effective Nov 1, 2012 - All prices subject to change without notice

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