Secure Order Form - Statistical Solutions, LLC

ORDER FORM...red fields are required

Your Information			Referral Information	Please enter referral information below
First name			First, Last Name
Last Name			Company Name
Title/Position
E-Mail
Phone
Fax

Billing Information			Shipping Information	Check box if same as Billing Information
Company Name			Company Name
Address			Address
City			City
State			State
Zip Code			Zip Code

Training Products
Training Material
On-Site Training		(Statistical Solutions, LLC will provide a qualified instructor at your facility)

Site License			Quantity	Sub-Total $
Instructors Guide©			Quantity	Sub-Total $
Students Guide©			Quantity	Sub-Total $
..........................................................................................................................................................................
				*Total Cost $

*Any volume discounts are automatically applied to the total cost.
*Any special discounts will be applied to the confirmation e-mail and invoice.

Make Order Firm?	Yes No

Thank you!	Selecting "Yes" means you understand and agree that this is a firm order and Statistical Solutions will begin processing the order immediately once submitted. You will receive a confirmation e-mail to the address you provided in this form and will be invoiced accordingly based on the products and quantities you selected (FOB Destination).

Survey Question	Please take a moment to answer our survey question.
	Would you like the ability to order using a credit or debit card online?
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Questions? Comments?

Statistical Solutions, LLC