Emergency Preparedness Order Form 2017
Full Name
*
First Name
Last Name
EMERGENCY SUPPLIES
Quantity
55 Gallon Water Tank with spigot ($ )
160 Gallon Water Tank with spigot ($ )
260 Gallon Water Tank with 2 spigots ($ )
500 Gallon Water Tank with 2 spigots ($ )
Water Bricks (set of 10) ($ )
Five Year Emergency Water Storage Treatment Kit ($ )
SAWYER Water Filter Mini ($ )
GIS Outdoors/ Water Cube 15L ($ )
Harvest Right - Home Freeze Dryer LARGE ($ )
Harvest Right - Home Freeze Dryer MEDIUM
($ )
Harvest Right - Home Freeze Dryer SMALL
($)
MedPacks - Hiker Medic ($ )
MedPacks - Cuts & Scrapes ($ )
MedPacks - Bleed Stopper ($ )
MedPacks - Pet Medic ($ )
MedPacks - Burn ($4,000.00)
Sportsman 200 Medical Kit ($ )
Mountain Backpacker Medical Kit ($ )
SuperSkin Blister Tape ($ )
72 hour 1-person Emergency Food Pail
(back ordered) ($ )
Deluxe Emergency 30-day Food Supply - 1 person
(back ordered) ($ )
6-month 1-person Emergency Shelter-in-Place Food
Supply Kit (back ordered) ($ )
1 Year 1- Person Premium Emergency Evacuation Food Supply Kit
(back ordered) ($ )
SOG/ PowerPlay Hex Bit Kit With Carry Case ($ )
SOG Folding Saw ($ )
Barebones - Field Hatchet ($ )
Barebones - Pulaski Axe ($ )
Barebones - LED Beacon Lantern ($ )
Barebones - Forest Lantern ($ )
Barebones - Fire Pit ($ )
NoBox - Chef Knife ($ )
NoBox - Single Blade Folding Knife($ )
NoBox - Double Blade Folding Knife ($ )
Barebones - Outfitter Tent ($ )
Big Agnes - Copper Spur HV UL3 ($ )
Big Agnes - Big house 6 ($ )
Big Agnes - Anvil Horn 30 Sleeping Bag ($ )
Klymit - KSB 15 Sleeping Bag ($ )
Klymit - KSB 20 Sleeping Bag ($ )
Klymit - KSB 35 Sleeping Bag ($ )
Klymit - Wild Aspen 20 Sleeping Bag ($ )
Klymit - Static V Sleeping Pad ($ )
Klymit - Insulated Static V Sleeping Bag ($ )
Klymit - Static V Sleeping Pad ($ )
GCI Outdoor - Freestyle Rocker ($ )
GCI Outdoor - Kickback Rocker ($ )
GCI Outdoor MaxRelax Pod Rocker ($ )
GCI Outdoor Master Cook Station ($ )
GCI Outdoor Wilderness Backpacker ($ )
Peak Refuel - Home-style Chicken & Rice ($ )
Peak Refuel -Beef Stroganoff Freeze Dried 2 Serving ($ )
Peak Refuel -Beef Chili Mac Freeze Dried 2 servings ($ )
Peak Refuel - Chicken Pesto Pasta Freeze Dried 2 serving ($ )
Peak Refuel - Chicken Alfredo Pasta Freeze Dried 2 serving ($ )
Peak Refuel - Chicken Teriyaki Rice Freeze Dried 2 serving ($ )
Peak Refuel - Beef Pasta Marinara Freeze Dried 2 serving ($ )
Peak Refuel - Sweet Pork & Rice Freeze Dried 2 serving ($ )
Peak Refuel - Breakfast Skillet Freeze Dried 2 serving ($ )
Peak Refuel - three Bean Chili Mac Freeze Dried 2 serving ($ )
Peak Refuel - Mountain Berry Granola Freeze Dried 2 serving ($ )
Peak Refuel - Strawberry Granola Freeze Dried 2 serving ($ )
Peak Refuel - Redi Lite Firepuffs" Emergency Mini Fire
Starter Kit ($ )
Survival Blanket ($ )
Emergency Blanket ($ )
Heavy Duty Emergency Blanket ($ )
All Season Blanket ($ )
Heat Reflective Poncho ($ )
Escape Lite Bivvy ($ )
Emergency Bivvy ($ )
Emergency Shelter Kit ($ )
Emergency Whistle ($ )
GSI Outdoors Halulite Minimalist Complete ($ )
GSI Outdoor Pinnacle Dualist Complete ($ )
GSI Outdoors Selkirk 540 Camp Stove ($ )
GSI Outdoors Selkirk 460 Camp Stove ($ )
GSI Outdoors Pinnacle Cannister Stove ($ )
GSI Outdoors Pinnacle Backpacker Nesting Cookset ($ )
Barebones Living Garden Spade ($ )
Barebones Living Cultivator Hand Tool ($ )
Barebones Living Garden Spade ($ )
Barebones Living Hori Hori Ultimate Tool ($ )
Barebones Living Hori Hori Ultimate Tool and Sheath ($ )
Barebones Living Pruner & Sheath ($ )
Datrex 2400 Calorie Food Rations ($ )
Datrex 3600 Calorie Food Rations ($ )
Datrex 4.2 oz Emergency Drinking Water Pouch ($ )
Emergency Wool Blanket ($ )
Augason Farms - Pinto Beans 4 Gal Pail ($ )
Augason Farms - Creamy Potato Soup ($ )
Augason Farms - Vegetable Stew Blend #10 Can ($ )
Augason Farms - Southwest Chili Mix # 10 Can ($ )
Augason Farms - Cheese Blend Powder ($ )
Augason Farms - Black Bean Burger Mix #10 Can ($ )
Augason Farms - Freeze Dried Shredded Colby Jack Cheese
#10 Can ($ )
Augason Farms - Freeze Dried Shredded Mozzarella Cheese
#10 Can ($ )
Augason Farms - Freeze Dried Blackberries #10 Can ($ )
Augason Farms - Freeze Dried Seedless Red Grapes #10 Can ($ )
Augason Farms - Freeze Dried Diced Mango #10 Can ($ )
Augason Farms - Freeze Dried Raspberries #10 Can ($ )
Augason Farms - Freeze Dried Blueberries #10 Can ($ )
Augason Farms - Freeze Dried Strawberries #10 Can ($ )
Augason Farms - Potato Gems #10 Can ($ )
Augason Farms - Potato Shreds #10 Can ($ )
Augason Farms - Potato Slices #10 Can ($ )
Augason Farms - Diced Carrots #10 Can ($ )
Augason Farms - Freeze Dried Sweet Corn ($ )
Augason Farms - Wheat Hard White 4 Gal Pail ($ )
Augason Farms - Regular Rolled Oats 4 Gal Pail ($ )
Augason Farms - Chopped Onions #10 Can ($ )
Augason Farms - Tomato Powder #10 Can ($ )
Augason Farms - Cross Cut Celery #10 Can ($ )
Augason Farms - Diced red & Green Bell Peppers #10 Can ($ )
Augason Farms - Honey Powder #10 Can ($ )
Augason Farms - Vegetable Garden Seeds #10 Can ($ )
Augason Farms - Funeral Potatoes Pouch ($ )
Augason Farms - Long Grain White Rice 4 Gal Pail ($ )
Augason Farms - White Granulated Sugar 4 Gal Pail ($ )
Augason Farms - Apple Slices #10 Can ($ )
Augason Farms - Buttermilk Pancake Mix # 10 Can ($ )
Augason Farms - Honey White Bread, Scone & Roll Mix
# 10 Can ($ )
Augason Farms - Scrambled Egg Mix #10 Can ($ )
Augason Farms - Whole Egg Powder # 10 Can ($ )
Augason Farms - Butter Powder # 10 Can ($ )
Augason Farms - 100% Real Non-fat Dry Milk #10 Can ($ )
Augason Farms - Morning Moo's Low Fat Milk Alternative
#10 Can ($ )
Augason Farms - Morning Moo;s Low Fat Chocolate Milk Alternative #10 Can ($ )
Augason Farms - cheesy Broccoli Soup Mix #10 Can ($ )
Midland Radios - ER310 E+Ready Emergency Crank Weather Radio ($ )
midland Radios - ER210 E+Ready Compact Emergency Crank WX Radio ($ )
Midland Radios - ML500 LED Lantern ($ )
Midland Radios EX210VP E+ Ready Bundle ($ )
Midland Radios - XT511 GMRS Base Camp ($ )
MIdland Radios _ EX37BP W+Ready Walkie Talkie Kit ($ )
Midland Radios - X - Talker T51VP3 Walkie Talkie
MIdland Radios - HH50B Pocket Weather Alert Radio
MIdland Radios - DBR2500 Dual Band Amateur Two-way Radio
Midland Radios - GXT1050VP4 Two-Way Radio
COST OF SUPPLIES
Subtotal
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Total Cost
Total Cost w/ Tax
How much do you want to pay immediately?
Remaining Balance
Monthly amount taken out of the next 26 paychecks
I agree to have the above amount taken out of my next 26 paychecks.
Signature
*
E-mail
*
Submit
Clear Form
Print Form
Should be Empty: