Autism Coach School Order Form
6670 Sauk Trail, Saline
Michigan 48176, Fax: 877-485-1440, Email:
sales@autismcoach.com. |
Ship to:
Phone (required):
|
|
Name:
|
|
Title:
|
|
School:
|
|
Street Address:
|
|
City/State/Zip:
|
|
Email:
|
|
Bill to: (only if different from Ship to)
Phone (required):
|
|
Name:
|
|
Title:
|
|
School:
|
|
Street Address:
|
|
City/State/Zip:
|
|
Email:
|
|
Order:
Quantity
|
Title
|
Item Number
|
Price
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| * Shipping and handling for U.S. customers who
mail in a check or money order are: $7.50 for orders under $50, $10.50
for orders under $100, $15.50 for orders under
$500, $25.50 for
orders under $2000, and free shipping for orders over $2000. If
you wish to get a requote on shipping based on weight or other
shipping methods, please contact www.autismcoach@comcast.net
|
Subtotal
|
|
Shipping and Handling*
|
|
Total
|
|
Payment:
 |
Payment Enclosed (check or money
order). Please make checks payable to Autism Coach. |
|
Charge to: ___ Master
Card ___ Visa |
|
Account #
___________________________________________________________________ |
|
Expiration Date
_______________________________________________________________ |
|
Signature
___________________________________________________________________ |
|
Please bill purchase order #
_____________________________________________________ |
|
|
|