Examination Fax/Mail Order
Texts currently used:
________________________________________________________________
________________________________________________________________
I would like to order the following examination copies:
Title/Author: ___________________________________________________
Examination Price: ____________
Course name: __________________________________________________
Anticipated enrollment:____________
Title/Author: ___________________________________________________
Examination Price: ____________
Course name: __________________________________________________
Anticipated enrollment:____________
Title/Author: ___________________________________________________
Examination Price: ____________
Course name: __________________________________________________
Anticipated enrollment:____________
Title/Author: ___________________________________________________
Examination Price: ____________
Course name: __________________________________________________
Anticipated enrollment:____________
I do not plan to consider the following titles for a course, but would like to purchase them at the list price.
Title/Author: ___________________________________________________
____ Cloth ____ Paper Price: _______________
Title/Author: ___________________________________________________
____ Cloth ____ Paper Price: _______________
Title/Author: ___________________________________________________
____ Cloth ____ Paper Price: _______________
SHIPPING: U.S.: Add $3.50 S/H charge for first book, plus $.75 for each additional book. Canada: Add $4.00 S/H charge for first book, plus $.75 for each additional book. U.S. FUNDS ONLY.
Total cost of Books at LIST price: ________
Total Cost of Books at EXAM price (from above): ________
TOTAL COST OF BOOKS: ________
IN Residents add 6%: _________
MA Residents add 5%: _________
Shipping & Handling: _________
TOTAL ORDER: _________
Payment and Address Information
PLEASE NOTE: An academic affiliation must be provided in order to receive exam copies.
___ MasterCard ____ Visa ____ Check enclosed
Name on Credit Card: ____________________________________________
Credit Card No.: _________________________________________________
Security Code:______
Signature: _____________________________________________________
Exp. Date: ___________ Daytime Phone: ____________________
Billing Address: (required)
Name: ________________________________________________________
Department: ___________________________________________________
School: _______________________________________________________
Street Address: ________________________________________________
City, State, Zip Code: ____________________________________________
Shipping Address: (if different)
Name: ____________________________________________________________
Department: ________________________________________________________
School: ____________________________________________________________
Street Address: ______________________________________________________
City, State, Zip Code: __________________________________________________
TOLL FREE fax in the U.S. and Canada (1-800) 783 9213
