Sociometrics Corporation
170 State Street, Suite 260
Los Altos, CA 94022-2812
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Fax: 650-949-3299
Phone: 650-949-3282
E-Mail: socio@socio.com

Sociometrics Web Order Form

To Order:
or:
or:
  • print and complete this form, & fax it to 650-949-3299,
  • print and complete this form, & mail it to Sociometrics (address above) ,
  • Call Sociometrics' Phone Order Hotline at 800-846-3475.
BILL TO
Name:
Organization:
Department:
Street Address:
City, State, Zip:
Phone (w/ ac):
Fax (w/ ac):
E-mail:

SHIP TO (only if different than above)
Name:
Organization:
Department:
Street Address:
City, State, Zip:
Phone (w/ ac):
Fax (w/ ac):
E-mail:

PRODUCT CODE
(from catalog)		 PRODUCT DESCRIPTION UNIT PRICE
Subtotal:
TAX: CA Residents add 7.25%:
U.S. Shipping and Handling (UPS Ground or Priority Mail)
*Overseas orders will be charged actual shipping costs
FREE*
TOTAL:

Payment Type (check one):
Visa
Mastercard
Name on Credit Card:
Credit Card #:
Expiration Date:
3 Digit Credit Card Security Code: (found on the back of your credit card)
purchase order (Purchase Order must be returned with
this form by fax or mail before shipment)
check/ money order (check must be received before shipment)







Use the space below for any notes, comments, or special requests regarding this order.