GET ACQUAINTED PACKAGE ORDER FORM

HERZOG Keyboarding

8437 N. Coral Ridge Loop
Tucson, AZ 85704
Ph (520) 792-2550
Fx (520) 792-2551

Method of payment:
____ Check enclosed
____ Credit Card
____ Purchase Order:
         P.O #_________________

For
Grades

Use

Product
#

Unit
Price

Quantity
Ordered

Line
Total

Thru Grade 6

Elementary

GE

$30.00

   

Grade 6+

Secondary

GS

$30.00

   
Sales Tax 7.6% (Arizona Only)
Shipping/Handling ($6.00 each to addresses in U.S.)
TOTAL

Credit Card Information
____________________________________
Credit Card Number
____________________________________
Card Expiration Date
____________________________________
Name on Card
____________________________________
Signature


Educators:
Kindly also provide us with the following information
about your school or district, and your position:

__(_______)__________________________
Phone (Day)
__(_______)__________________________
Phone (Evening)
__(_______)__________________________
Your Fax Number
____________________________________
Your E-mail Address


Ship To:

____________________________________
Name of School or District
____________________________________
Address
____________________________________
City/State/Zip
____________________________________
Your Position
__(______)___________________________
Phone
____________________________________
District/School
____________________________________
Address
____________________________________
City/State/Zip
____________________________________
Attn:

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