Order FormTo order, print this form and mail or fax it to Gregorc Associates, Inc. GREGORC ASSOCIATES, INC.BOX 351 COLUMBIA, CT 06237 Phone or Fax: (860) 228-0093 ORDER INFORMATION |
Item Number |
Description |
Quantity Order |
Unit Price |
Total Price |
SHIPPING/HANDLING CHARGES |
Subtotal |
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Sales Tax * |
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Shipping & Handling |
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TOTAL |
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* SALES TAX INFORMATION |
CT Residents add 6% |
NC Residents add 7% |
SPECIAL DIRECTIONS |
SHIPPING INFORMATION | |
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Name: ___________________________________________ Title: ____________________________________________ Organization: ______________________________________ Street Address: ____________________________________ _______________________________________________ City: ______________________ State: _____ Zip: ________ Telephone: ( ) _________________________________ E-mail Address: ___________________________________ Fax Number: _____________________________________ Home Address: _________________________________ ________________________________________________ City: ______________________ State: _____ Zip: ________ We ship United Parcel Service whenever possible. |
BILL TO: ____ Organization ____ Home SHIP TO: ____ Organization ____ Home Is this your first order? ____ Yes ____ No PAYMENT INFORMATIONCredit cards cannot be accepted.
____ Check for total amount enclosed ____ Purchase Order enclosed |
The Phoenix symbol, Mind Styles and Gregorc Style Delineator are trademarks of Anthony F. Gregorc, Ph.D.
© 1999-2010 Anthony F. Gregorc, Ph.D.