-----Order Form-----
(Please print this form, fill it out, and mail it with your payment to complete your order.)

**Make Checks or Money Orders Payable to:  Joe Tompkins

Send this completed form with payment to:
Joe Tompkins
130 Wintergreen Ct
Covington, GA 30016


Your Name___________________________________________

-or-

School Name__________________________________________


Email Address (to receive registration code via Email-- Allow 2 weeks for reply):

_____________________________________ 


Mailing Address (to receive registration code via postal mail-- allow 5 weeks for reply)
-United States Addresses ONLY-- All others will receive code via email-

Street:______________________________________________________________

City________________________________State_________ Zip_________________________


Please indicate the product(s) you wish to register below:

________________________________________________________________________________________________
Product:			|      Quantity		|	Unit Price	|     Total	|
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Vocab-Flash (Single User)	|			|	$10.00 (US)	|		|
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Vocab-Flash (Site License)	|			|	$50.00 (US)	|		|
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StoryMaker (Single User)	|			|	$10.00 (US)	|		|
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StoryMaker (Site License)	|			|	$50.00 (US)	|		|
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									Total Enclosed: