form - Ages and Stages

ASQ Ordering Guide
ORDER FORM
Stock #
Qty
Title
Questionnaires, Online System, Training DVDs, and more
Questionnaires, Online System, Training DVDs, and more
Price
ASQWEB- __ __ __ __ __
ASQWEB- __ __ __ __ __
ASQWEB- __ __ __ __ __
ASQWEB- __ __ __ __ __
ASQ Discounts
Buy 6 or more copies of the same ASQ family product and SAVE:
6-10 copies: 5%
11-20 copies: 10%
21-50 copies: 15%
51-100 copies: 20%
101-200 copies: 25%
201-500 copies: 30%
501-1000 copies: 35%
1001-2500 copies: 40%
2501+ copies: 45%
Product subtotal (in U.S. dollars)
Shipping (see chart at bottom)
Order subtotal
PA, WA, TX, IN, & MD state sales tax
or GST (for CAN residents)*
(Please note: the ASQ-3TM Materials Kit has a discount limit of 35%. ASQ Pro,
ASQ Enterprise, and ASQ Family Access are not discounted.)
Grand total
Convenient ways to order:
CALL toll-free
1-800-638-3775
M-F, 9 a.m. to 6 p.m. ET.
FAX
410-337-8539
ONLINE
www.brookespublishing.com
MAIL order form to:
Brookes Publishing Co.
P.O. Box 10624
Baltimore, MD 21285-0624
Money-back guarantee! Ordering with Brookes is risk-free!
If you are not completely satisfied, you may return products within 30 days for a full credit of the purchase price (unless otherwise indicated).
Refunds will be issued for prepaid orders. Items must be returned in unused and resalable condition.
Policies and prices subject to change without notice. Prices may be higher outside the U.S.
o
Check enclosed (payable to Brookes Publishing Co.)
o
Purchase Order attached (bill my institution—P.O. MUST be attached)
Shipping & Handling
(For other shipping options and rates, call 1-800-638-3775,
in the U.S.A. and Canada, and 410-337-9580, worldwide.)
*We reserve the right to add an additional 2% order processing fee on all orders that require special processing.
o
Continental U.S.A.; U.S.A. territories &
protectorates; AK, HI & PR‡
Please charge my credit card: o American Express o MasterCard o Visa o Discover
Credit Card # _____________________________________________________________________________ Exp. Date: _________
Security code (3 digit code on back of card, or 4 digit code on front of card for American Express): __ __ __ __
Signature (required with credit card use): _______________________________________________________________________
Name: ______________________________________________________________________________________________________
Daytime Phone: _____________________________________________________________________________________________
Organization:________________________________________________________________________________________________
Street Address: ______________________________________________________________________________________________
Complete street address required.
o residential o commercial
City/State/Zip: ___________________________________________________________________ Country: ___________________
o Yes! I want to receive the ASQ News & Updates e-newsletter! My e-mail will not be shared with any other party.
Write in your title and check area of specialty: ____________________________________________________________________
o K–12
o 4-year College/Graduate
o Community College/Vocational oClinical/Medical
Add*
US$50.00 and under
$6.50
US$50.01 and over
13%
‡
AK, HI, and PR please add an additional US$12.00. Orders
ship via UPS Air.
Please call or email for expedited shipping options and rates.
Canada
For subtotal of
Add*
US$70.00 and under
$10.50
US$70.01 and over
15%
Orders for Canada are consolidated for shipping twice each
month. For minimum shipping time, please place your orders
by the 9th or 24th of each month.
*calculate percentage on subtotal
*PA,WA, TX, IN & MD residents: Please add state sales tax.
ABOUT YOU
o Birth to Five
For subtotal of
Canadian residents: please add your GST. Sales tax should be
calculated based on the total order (including shipping) in U.S. dollars. If
sales tax is calculated incorrectly, Customer Service will correct it prior
to processing your order and the adjusted total will appear on your
invoice.
o Community Services
1-800-638-3775
1-800-638-3775
o Association/Foundation
YOUR LIST CODE IS ASQWEB
2/15
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