FEEDING AND FLUID INTAKE GLASSES REQUEST FORM
NOTE: FEES ARE FOR SHIPPING AND HANDLING
(Payment Method is Visa, Mastercard or Debit Card ONLY - P.O.'s are not accepted)

Within this document, select the state page and state for which you wish to order the feeding task or fluid intake tasks glasses.

OPTIONS ARE:
* Arkansas, Ohio STNA and Wisconsin Feeding Task Glasses Set ($20/set)
* Arizona and Missouri Feeding Task Glasses Set ($20/set)
* Arizona - 120ml Glass Only ($15/glass)
* Montana, North Dakota, Oklahoma, Oregon and South Dakota Feeding and Fluid Intake
Glasses Set ($25/set)
* Nevada Feeding Task Glass ($8/glass)
* Tennessee Feeding Task Glasses Set ($20/set)

Click NEXT or BACK at the bottom of each page to get to the state page for the glasses sets you wish to order.

Once you have selected the state you wish to order glasses sets for, click the box next to the state and then enter the quantity of sets you are requesting.

Then click NEXT at the bottom of the page to get to the required SHIPPING and CREDIT CARD information pages. When you have completed the form, click SUBMIT.
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