Autism Coach School Order Form
6670 Sauk Trail, Saline
Michigan 48176, Fax: 877-485-1440, Email:
sales@autismcoach.com. |
Ship to:
Phone (required):
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Name:
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Title:
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School:
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Street Address:
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City/State/Zip:
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Email:
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Bill to: (only if different from Ship to)
Phone (required):
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Name:
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Title:
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School:
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Street Address:
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City/State/Zip:
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Email:
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Order:
Quantity
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Title
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Item Number
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Price
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| * 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
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Shipping and Handling*
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Total
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Payment:
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Payment Enclosed (check or money
order). Please make checks payable to Autism Coach. |
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Charge to: ___ Master
Card ___ Visa |
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Account #
___________________________________________________________________ |
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Expiration Date
_______________________________________________________________ |
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Signature
___________________________________________________________________ |
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Please bill purchase order #
_____________________________________________________ |
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