To place an order... Copy and Paste this order form... 1. into your e-mail. Complete the order and forward to: PESorder@aol.com; OR 2. into your word processing program. Complete the order and fax to: 512/233-0935; OR 3. into your word processing program. Complete the order and mail to: Psycho-Educational Services 5114 Balcones Woods Drive Suite 307-163 Austin, Texas 78759 ------------------------------------ORDER FORM------------------------------------ BILLING INFORMATION: Name: Address (line 1): Address (line 2): City, State, Zip: Phone (including area code): SHIPPING INFORMATION (if different than billing): Name: Address (line 1): Address (line 2): City, State, Zip: Phone (including area code): Enter in the blank the number of units you are purchasing. ______ # 0271 Complete FEAT Kit (@$149) (Complete FEAT includes the Examiner's Manual, 25 copies of the Contextual Matching Inventory, 25 copies of the Checklist of Strengths and Limitations, 25 copies of the Checklist of Technology Experiences, 25 copies of the Technology Characteristics Inventory, 25 copies of the Individual-Technology Match, and 25 copies of the Summary/Recommendations Booklet) Components (if sold separately): ______ # 0272 FEAT Examiner's Manual (@$55) ______ # 0273 Contextual Matching Inventory (25 copies; @$17) ______ # 0274 Checklist of Strengths and Limitations (25 copies; @$17) ______ # 0275 Checklist of Technology Experiences (25 copies; @$17) ______ # 0276 Technology Characteristics Inventory (25 copies; @$12) ______ # 0277 Individual-Technology Evaluation Scale(25 copies; @$17) ______ # 0278 Summary/Recommendations Booklet (25 copies; @$25) ______ # 0272SK FEAT Specimen Kit (The FEAT Specimen Kit includes the Examiner's Manual and one copy of each of the FEAT forms -- Contextual Matching Inventory, Checklist of Strengths and Limitations, Checklist of Technology Experiences, Technology Characteristics Inventory, Individual-Technology Evaluation Scale, Summary and Recommendations Booklet @ $55.) ______ #11880: TOPA-2+ Complete Kit ($228.00) (COMPLETE TOPA-2+ KIT INCLUDES: Examiner's Manual, 50 Kindergarten Summary Forms, 50 Early Elementary Summary Forms, 25 Student Booklets for Kindergarten, and 25 Student Booklets for Early Elementary, all in a sturdy storage box. 2004) Components (if sold separately): ______ #11881: TOPA-2+ Examiner's Manual ($79.00) ______ #11882: TOPA-2+ Kindergarten Summary Forms, pad of 50 ($33.00) ______ #11883: TOPA-2+ Early Elementary Summary Forms ($33.00) ______ #11884: TOPA-2+ Kindergarten Student Booklets (25) ($51.00 ______ #11885: TOPA-2+ Early Elementary Student Booklets (25) $51.00 ____ Order #15000: GORT-5 Complete Kit ($275.00) (COMPLETE GORT-5 KIT INCLUDES: Examiner's Manual, 25 Examiner Record Booklets, Form A (25) , Examiner Record Booklets, Form B (25), all in a sturdy storage box. 2012) Components (if sold separately): ______ #15001: GORT-5 Examiner's Manual ($92.00) ______ #15002: GORT-5 Student Book ($65.00) ______ #15003: GORT-5 Examiner Record Booklets, Form A) (25) ($59.00) ______ #15004: GORT-5 Examiner Record Booklets, Form B) (25) ($59.00) ______ #10965: GDRT-2 Complete Kit ($272.00) (COMPLETE GDRT-2 KIT INCLUDES: Examiner's Manual, Adventures in Fancyland Storybook, Student Book Form A, Student Book Form B, 25 Examiner/Record Forms A, and 25 Examiner/Record Forms B, all in a sturdy storage box. 2004) Components (if sold separately): ______ #10966: GDRT-2 Examiner's Manual ($80.00) ______ #10967: GDRT-2 Student Form Book A ($55.00) ______ #10968: GDRT-2 Student Form Book B ($55.00) ______ #10969: GDRT-2 Adventures in Fancyland Storybook ($5.00) ______ #10970: GDRT-2 Examiner/Record Form A (25) ($51.00) ______ #10971: GDRT-2 Examiner/Record Form A (25) ($51.00) ______ Subtotal amount ______ In the United States, add 10% shipping and handling; Canada, 15%; others, 20% ______ Texas residents add 8.25% sales tax ______ Total (US funds only) Place an X in front of the appropriate billing procedure _____ PO#(__________) _____ Bill me (Sorry, we do not accept credit cards.) _____ Check enclosed (if entered by mail) All orders are sold on 30-day approval. If you are not completely satisfied, you may return any product within 30 days of receipt. Please contact PES to receive authorization and necessary shipping instructions for returns. Prepaid orders will receive a prompt refund, minus the handling charges. If prices on your order are incorrect, we reserve the right to exceed the amount up to 10 percent unless otherwise noted on your order. Terms are net, F.O.B. Austin, Texas; prices are subject to change without notice. All orders are to be paid in U.S. FUNDS. Most shipments are done using USPS Priority Mail or UPS Ground (4 to 5 working days) unless otherwise specified. Alternate shipping (e.g., UPS or FED-EX overnight) can be done upon request and will be charged at cost, plus a 5% handling fee. Please note the alternate shipping request by below: ______ UPS overnight delivery ______ UPS 2nd day delivery ______ Federal Express overnight delivery ---------------------------------------------------------------------------------- Thank you very much. We appreciate your business! Click here to e-mail your order. Click here to return to the Home page.