Order Form

To 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

SHIPPING/HANDLING CHARGES	Subtotal
For orders under $100: ADD $10.00	Sales Tax ^*
For orders over $100: ADD 10% of Subtotal	Shipping & Handling
For orders over $600: Add 8% of Subtotal	TOTAL
Alaska, Hawaii and Canada, ADD extra $10 shipping charge UPS Next Day and 2nd Day Air Service is available. Please contact us for info.
International Shipments: Please contact us regarding details and costs.

^* SALES TAX INFORMATION

CT Residents add 6%

NC Residents add 7%

SPECIAL DIRECTIONS

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

Credit cards cannot be accepted.

All orders UNDER $25 must be prepaid by check.
Personal orders OVER $25 will be billed by invoice. Organizations must send an authorized Purchase Order.

____ Check for total amount enclosed
(U.S. Dollars on U.S. Bank or International Money Order)

____ 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.