PLEASE FILL IN ALL SECTIONS IN FULL:

Purchasing establishment(s) details

Customer 1

Customer details:

Name: ……………………………………………………………………………………………………………………..…

Mr/Mrs/Ms/Other: ………………………………………………………………………………………………………

School Address: …..………………………………………………………………………………………….…………

Country: ………………………………………………………………………………………………………….…………

Job title: ……………………………………………………………..………………………………………………………

Department: ………………………………………………………………………………………………………………

Telephone number: ……………………………………………………………………………………………………

E-mail address: ………………………….……………………………………………………………………………..

Super Admin e-mail address: ……………………………………………………………………………………

Super Admin Job title: ………………………………………………………………………………………………

[ü appropriate section(s) below

The customer would like to:

(Please tick the relevant option then list title and ISBN)

ISBN & TITLE

[ ] Register for a free trial of ……………………………………………………………………..…….….

[ ] Purchase a Subscription for………………………………………………………………………..……
[ ] Purchase a Subscription Plus for …………………………………………………………………….

[tick appropriate section below] Size of school:

[ ] Small school (up to 900 students on roll)

[ ] Large school (901+ students on roll)