ORDER
FORM FOR USE WITH COMPANY PURCHASE ORDERS AND US POSTAL MONEY ORDERS
f a x # . . . 3 3 0 - 2 9 7 - 7 0 4 3
Mailing Address
Brainviews, Ltd.
3175 Bird Drive
Ravenna, Ohio 44266, USA
To order online and pay by credit card, CLICK HERE.
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Shipping
Information . . .
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| Name: | |
| Company/Institution Name: | |
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Address: |
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| Phone: | Fax: |
| E-Mail: | Internet Web Site Address:: |
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Billing
Information . . .
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| Billing Contact Name: | |
| Company/Institution Name: | |
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Address:
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| Phone: | Fax: |
| E-Mail: | Internet Web Site Address: |
| US Postal Money Order Number: | |
| Purchase Order Number: | |
| Purchasing Agent: : | Date: |
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Quantity
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Item Description |
Price
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Total |
| Animated Brain CD-ROM Latest Version 2.0 |
$99.95
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| Animated Brain eBook for Windows |
$11.95
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| Animated Brain Text Book |
$24.95
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| Graphic Brain CD-ROM |
$99.95
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Sub-Total:
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| Ohio residents please add 7% sales tax |
Tax:
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| Please add $6 for US; $12 for international shipping and handling |
S
& H:
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Total:
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