Non Local Hygiene Kit Order **If you would like to inquire about a hygiene kit before making your purchase, please visit Hygiene Kit Inquiries** NATIONAL HYGIENE KIT ORDER FORM Will Your Build Take Place in Orlando or Las Vegas?*Please Select OneYesNoPLEASE CLICK HERE TO BE DIRECTED TO OUR LOCAL HYGIENE KIT ORDER FORM!Contact InformationCompany Name*Group/Event Name*Contact Name*Phone*Email* TimingShipping Venue Name*Is this a business?*YesNoIs delivery date flexible?*YesNoDate Range*Event Date* Date Format: MM slash DD slash YYYY Event Start Time* : HH MM AM PM Event End Time* : HH MM AM PM Shipping InformationOrder Date* Date Format: MM slash DD slash YYYY Requested Delivery Date* Date Format: MM slash DD slash YYYY Please note: Standard Kits with a delivery date within 30 days OR Specialized Kits with a delivery date within 45 days of the order date will be subject to a 25% rush fee to cost of kits. Event Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Special instructions for shipping label (note n/a if nothing to add)*N/AIs this shipment going to a tradeshow?*YesNoDoes the shipping location have a dock?*yesNoDoes the shipping location have a forklift?*YesNoIs the shipping location in a residential area?*YesNoDoes this shipment require inside delivery, and if so is there a delivery fee?*YesNoIs an appointment needed for delivery?*YesNoClient and/or agent is responsible for any special delivery methods outside of Clean the World’s standard shipping and handling direct to venue procedures. Clean the World is not responsible for additional third party vendor shipping and handling fees. Clean the World notes - please read and initial box to the right to accept: Orders over 300 kits are palletized so please confirm that they can be accepted that way Client is responsible for extra charges incurred for any special treatment of shipment If an express service is requested, it can be provided, however at an additional charge. These fees are determined based on distance and total weight and will be presented as a flat fee. Initials*Standard Hygiene Kit FeesNumber of Standard Hygiene Kits to OrderPlease enter a number greater than or equal to 100.AssemblyUnassembledPre-AssembledLess Than 501 kits at $6.25 each Price: $0.00 501 to 2000 kits at $5.25 each Price: $0.00 2001 to 5000 kits at $5.00 each Price: $0.00 Greater than 5000 kits at $4.75 each Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Specialized Hygiene Kit FeesNumber of Children's Hygiene Kits to OrderPlease enter a number greater than or equal to 100.Number of Women's Hygiene Kits to OrderPlease enter a number greater than or equal to 100.Number of Veteran's Hygiene Kits to OrderPlease enter a number greater than or equal to 100.Total Number of Specialized KitsAssemblyUnassembledPre-Assembled500 Kits or Less at $7.50 each Price: $0.00 501 Kits to 2000 kits at $6.50 each Price: $0.00 2001 Kits to 5000 kits at $6.25 each Price: $0.00 More than 5000 kits at $6.00 each Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Rush Fee (If Applicable) Price: $0.00 Personnel Fees*Please consult a CTW representative before entering amounts for Personnel Fees and Travel Fees Speaker Fees: $500 - $2500 plus travel Event Lead: $100/hr plus travel Event Support Staff: $50/hr plus travel Travel FeesApproved Travel Expenses up to: These Expenses are to includeAirfareLodging/AccomodationsMealsGround TransportationOtherPlease Specify Alternate Included ExpensesTotal For This Order $0.00 BillingBilling Contact Company*Billing Address* Select if Same as Contact Information Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Billing Method*Please Select OneCredit Card*eCheck / ACH*Please Enter Your Credit Card Information* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Please Enter Your Bank Information* Name on Account Bank Name Routing Number Account Number CheckingSavingsAccount Type *Please note that order is not confirmed until full payment is received. *All sales are final and no refund will be issuedEnd Recipient/Charity Partner SelectionPlease match me with options in my areaI have selected the following charity (enter below)Charity PartnerSignatureLess than 30/45 days?