Note: All information provided on this form is kept in strict confidence.

1. Contact Information

Name _________________________ School or Organization Name: ______________________

Street Address: ________________________________________________________________

City:____________________________________ State: _____________ ZIP Code: ___________

Country: ________________________ E-mail Address: __________________________________

Daytime Phone: __________________________________ Fax: ___________________________

2. Billing Information

Purchase Order / Check #:______________________ Date Authorization Issued: _______________

Authorized Name: ________________________________ Title: ____________________________

3. Choose License ( Prices are in U.S. Dollars)

______ School Building License: Grants 1 year of access to all staff within a bulding. $375.00

______ School District License: Grants 1 year of access to all staff over multiple buildings. $650.00

4. Licensing Agreement

All materials can be used and photocopied for classroom use only. Our products cannot be used for commerical means.

Signature: X_______________________________________________

5. Submitting Order

In order to finalize the order:

1. Choose a Username: _________________ Choose a password : _____________
   
   
2. Make checks payable to "TMS".
3. Mail purchase order, check, money order, or credit card information to:

TMS
PO Box 1107
Truro, MA 02666
USA