Order Form

2000 Appleby Line, Suite 354, Burlington, ON L7L 7H7

Peirce Educational Consulting is pleased to take World Wide institutional orders for it's publications via the World Wide Web. To ensure accuracy, a confirmation of your order will be emailed back to you within 48 hours. For pricing information and policies refer to the price list. Individuals wishing to place an order should print this page and mail it with payment enclosed to: Peirce Educational Consulting. Sorry, no credit card orders.

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Please provide the following contact information (* required fields):

First name*

Last name*

Title

Organization*

Street address*

Address (cont.)

City*

State/Province*

Zip/Postal code*

Country

Work Phone*

Fax

E-mail*

Please provide the following ordering information:

QTY DESCRIPTION

BILLING

Purchase order #

Account name

BILLING ADDRESS (if different from above)

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

First name*
Last name*
Title
Organization*
Street address*
Address (cont.)
City*
State/Province*
Zip/Postal code*
Country
Work Phone*
Fax
E-mail*

	BILLING ADDRESS (if different from above)
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Order Form

Last revised: November 12, 2009