What If? Game order form

WHAT IF? A CRITICAL THINKING GAME ORDER FORM

To send an order by mail or fax, please complete the form and press "print".

If you are paying by check, please complete and print the form and mail to:

Kathleen Walsh Free	What If? A Critical Thinking Game
PO Box 356	Madison IN 47250

If you wish to use a purchase order, please fax a copy of the order form and purchase order to: 812-866-5845

Please provide the following contact information:

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail

SHIP TO:

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

PAYMENT INFORMATION

Purchase Order #

Account/Organization Name

Check # (NO cash)

Credit Card Number

Expiration date

Signature

Please provide the following ordering information:

DESCRIPTION	PRICE	QUANTITY
Critical Care Nursing	$50.00
Emergency Nursing	$50.00
Fundamentals of Nursing	$50.00
Health Assessment	$50.00
Maternal-Child Nursing	$50.00
Medical-Surgical Nursing I	$50.00
Medical-Surgical Nursing II	$50.00
Pediatric Nursing	$50.00
Psychiatric-Mental Health Nursing	$50.00
Surgical Nursing	$50.00

Please provide the following ordering information for Specialty Games:

DESCRIPTION	PRICE	QUANTITY
What Next? Game	$60.00
ElderLife Game	$50.00

DESCRIPTION	PRICE	QUANTITY
Shipping with delivery confirmation; FLAT RATE	$5.00

Order total:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

	SHIP TO:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

PAYMENT INFORMATION
Purchase Order #
Account/Organization Name