ORDER FORM


Facility / Office
 
Contact Person
 
Purchase Order Number
 
Address
 
Suite No
 
City
 
State
 
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Phone Number
 
Fax Number
 
Email Address
 
Handbook Quantity
   
2012-2013 New Edition*
  @$21.00 each
2011-2012 Edition
  @$21.00 each
  Data Disc
Data Disc
  First time purchase $250
Update $75
  (individual system use price)
   
Tax Exempt?
 
 


Shipping charge:
2011/2012 Edition
$3.00 for first book, $0.25 for each additional book.

2012/2013 Edition
$3.00 for first book, $0.25 for each additional book.

$2 price break per book for orders more than 24 books.

We do not accept credit cards. You will receive an
invoice with your book(s).

Tax: per your county (include book total and shipping to determine total tax - per state guidelines)

*Due May 2012.