COTC - JEWELS - Order Form for use with offline payment purchases

Name of Organization
Purchase Order
Your Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
I am ordering as a*

Private IndividualEducational InstitutionCorporation
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Billing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Special Note: if you wish to order multiple copies please indicate the quantity and we will get back to you with shipping costs
Quantity (if only 1 skip this)
For single orders:
prevnext( X )
COTC JEWELS DISC 1 (175 CLIPS): $199.00

COTC JEWELS DISC 2 (144 CLIPS): $199.00

COTC JEWELS DISC 1 & 2 (319 clips)$298.00

S& H: Media Mail (7 to 14 days) $9.95

S&H: UPS Ground (US) 3-5 days$14.95

S&H: International Air Mail (10 to 20 days) $17.95

Total $0.00
Please read before submitting form

For individual purchasers please send a check in the amount indicated above to:

Learning Stewards

P.O. Box 23536
Anchorage, KY 40223

For Schools and Corporations, please fax a copy of your PO to 866-203-3241

for your records: Learning Stewards EIN: 26-3245117
Should be Empty: