Order Form

Use your browser to print this page, then complete the form and send to the location below:

SIGMA Assessment Systems
P.O. Box 610757
Port Huron, Michigan
USA 48061-0757
Phone: 1.800.265.1285
Fax: 1.800.361.9411

Phone #:

Purchase Order #:

Ship To:

Bill To:

Date shipment needed by:

Email Address:

Name of individual qualified to use these materials:

If your qualifications are not on file with us, a completed Test User Qualifications Form is necessary

Quantity

Item #

Item Description

Unit Price

Total

	Check/money order enclosed
	Institutional Purchase Order enclosed. (P.O. #)
	Visa
	MasterCard
	American Express
	Card #:
	Expiry:
	Signature:

Order Subtotal:

Shipping & Handling:
(see below for details)

Subtotal:

Shipping & Handling

*Applicable Taxes in Michigan 6%.
10% or $15.00 (whichever is greater) in the continental U.S. only.
Prepaid international orders are shipped via airmail. Please inquire about rates.