Use this form when placing orders by fax or by mail.
Directions are found at the end of the order
sheet. Simply use the print button
on your browser to print this form. (form date
11/1/05)
Step 1 -- Select the "Getting Ready to Test" materials you wish to purchase
______ Item #W401 - The Written Examination
Cost: $52 plus $8 shipping/handling (Priority Mail) - $60 total
______ Item #Q402 - The Oral Examination
Cost: $52 plus $8 shipping/handling (Priority Mail) - $60 total
______ Item #CS405 - A
Review and Preparation Manual for the Written
Clinical Supervisor Examination
Cost: $79 plus $6 shipping/handling (Priority Mail) - $85 total
______ Item #PV406 - A
Review and Preparation Manual for the Written
Prevention Specialist Examination
Cost: $79 plus $6 shipping/handling (Priority Mail) - $85 total
______ Item #M404 - A
Review and Preparation Manual for Drug
and Alcohol Credentialing Examinations
[ ] Cost: $149
plus $12 shipping/handling (FedEx Ground Shipment) - $161 total
[ ] Cost: $149 plus $15 shipping/handling (USPS Priority Shipment) - $164 total
Step 2 -- Personal and Payment Information
Be sure to enter all information requested. PLEASE PRINT
Complete Name: ________________________________________________________
Address: ________________________ City: ______________ State: ____ Zip: ______
E-mail address: ___________________________Daytime Phone Number:
__________
(We will send confirmation by e-mail when your order is shipped)
Payment method: Check_____ Money Order _____
Credit Card:
[ ] VISA [ ] MasterCard
[ ] American Express [ ] Discover
Card Number: _____________________________________
Expiration Date: ________ / ________
(month) (year)Order Total: ______________________
Step 3 -- Mail this form with payment (check, money order, credit card information) to:
Distance Learning Center, LLC
P.O. Box 29195
Santa Fe, NM 87592
Or fax this form with credit card information to: (801) 991-7081