Psychological And Educational Publications, Inc.

Order Form

Bill To:		Ship To:
First Name:		First Name:
Last Name:		Last Name:
Address 1:		Address 1:
Address 2:		Address 2:
City:		City:
State:		State:
Zip Code:	(5 or 9 digits)	Zip Code:	(5 or 9 digits)
Country:		Country:
Home Telephone:		Home Telephone:
Work Telephone:	ext.	Work Telephone:	ext.
Mobile Telephone:		Mobile Telephone:
Email Address:		Email Address:

Check if shipping address is the same as billing address.

Purchase Order Number:

NOTE: Tests and remedial activities offered by Psychological and Educational Publications, Inc., may be distributed only to qualified purchasers for use by educational specialists, teachers, school administrators, counselors, social workers, psychologists, occupational and physical therapists, speech and language pathologists, language specialists, physicians, optometrists, audiologists and other professionals who are trained to administer tests. Therefore, we must request the following information, unless special arrangements are made with our company:

Name of Qualified Professional:
Professional Lic. # (if applicable):

Please enter any questions or comments you may have in the space below:

Quantity	Inventory #	Description or Acronym	Price Each	Total







		Total (We will bill you)

*We do not accept credit card payments. After order has shipped, we will bill.

*Optionally, print out and mail or fax in an order form: orderform.pdf

*Nine percent (9%) handling and shipping costs will be added to the total order.

*California residents must add sales tax.

*Psychological and Educational Publications, Inc., reserves the right to correct any errors or omissions.

*Return Policy: Returns of materials in re-salable condition accepted only with prior authorization and within 30 days of receipt. Shipping and handling charges are not refundable. Costs of return must be paid by purchaser.