NISC Print Titles Purchase Form

NISC Print Titles Purchase Form

Please provide complete billing and shipping contact information below. We may need to contact you now about your order, or later for special product announcements. We will verify the information below prior to shipping any product.

SHIPPING ADDRESS (sorry, we cannot ship to a P.O. box): Enter all information applicable.

Name:			Telephone:
Organization Name:			Fax (important):
Div. /Department:
Street Address:			Street Address (cont.):
City:			State/Province:
Zip/Postal code:			Country:
E-mail:			URL:

BILLING ADDRESS (if different):

Account Manager:			Telephone:
Organization Name:			Fax (important):
Div. /Department:
Street Address:			Street Address (cont.):
City:			State/Province:
Zip/Postal Code:			Country:
E-mail:			URL:

Notes/Special Instructions:

Prices provided within the drop-down boxes below apply to customers located in the USA and Canada only and will differ for other regions of the world due to local conditions, service, expenses, taxes, etc.

Print Title	Qty.	Unit Price	Shipping &Handling¹	SubTotal





Maryland State customers: add 5% sales tax.
			TOTAL:

¹Shipping & handling :
Dictionary of Eldercare Terminology (2nd Edition) - US$6.50 within the United States. US$12.50 outside the United States.
Long Term Care at Home: "The Family Solution" - US$5.50 within the United States. US$11.50 outside the United States

METHOD OF PAYMENT:

Purchase order: P.O. # Amount

Bill me at the above address (subject to credit approval and fees where applicable; shipment may be delayed).

To order by VISA or MC please fax to NISC a copy of the order confirmation you receive after submitting this form to us. Please provide the following information: Credit Card Type (VISA or MC), Credit Card Number, Name on Credit Card and Expiration Date of Card. Fax to 410-243-0982.

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National Information Services Corporation NISC USA Wyman Towers, 3100 St. Paul Street, Baltimore, Maryland 21218 USA
Tel: +1 410 2430797	Fax: +1 410 2430982
Sales: sales@nisc.com
www.nisc.com
A Company in the Public Interest
Copyright © 2005 National Information Services Corporation. All Rights Reserved.