Name

_____________________________________________

Company name

_____________________________________________

Shipping address

_____________________________________________

City

_____________________________________________

State

______

ZIP

______________

Phone

_____________________________________________

FAX

_____________________________________________

E-mail address

_____________________________________________

Course number

______________

Cost

 
______________

Only pre-paid orders will be accepted. Select your method of payment:

__________  Check or money order enclosed

__________  Please charge to my credit card

Cardholder (print)

_____________________________________________

Check one

_____ VISA                           _____ MasterCard

_____ American Express      _____ Discover

Card Number

_____________________________________________

Security code

__________ 

Expires

_____________________________________________

Signature

_____________________________________________

Thank you! Your kit will ship via UPS within 7 days of receipt of your order.

Print out the online form, and mail the form to:

Stiles Education
3965 44th Street, SE
Grand Rapids, MI 49512

Or fax this form to: 616.698.7524