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ORDER FORM $98.00 ( Shipping $3.50 ea. Continental US - N.Y. residents add tax) AUTISM ACADEMY "Behavioral Programming for Children with Autism" CD-ROM Name: ___________________________________________________ School / Company: __________________________________________ Address: __________________________________________________ City: _________________________State: ______Zip Code:__________ N.Y County:___________________Country: ______________________ Phone Number: ___________________________ E-mail Address: ___________________________ Job title/function: ___________________________ Personal/Parent: [ ] Educational use: [ ] Libraries must contact us first! Quantity: _____ Shipping: [ ] Standard [ ] NextDay ($16.00) [ ] Priority 2 days ($7.00) Payment by: [ ] Visa [ ] Mastercard [ ]American Express [ ] Check [ ] MoneyOrder Name on Credit Card: _____________________________ Credit Card Number: _____________________________Expiration Date: _______ Signature: ______________________________________ Make Checks and MoneyOrders payable to: Digital Vista, inc. Mail to: Check System requirements before ordering! Returns for
unopened packages or defective discs only. |