BasketMath V3 Subscription Order Form

Mail Order Form

Please Print, Complete and Send this form.

Name
____________________________________

Organization:
____________________________________

Address:
____________________________________

City:
____________________________________

State
____________________Zip:_____________

Email:
____________________________________

_______________
DATE:
Requested Activation Date (subscriptions only). If you do not provide one, we will assign one to you. Please allow for a reasonable mail order processing time.

QTY	DESCRIPTION	PRICE	TOTAL
______	BasketMathV3 One Day Subscription*	$3.50	______
	New York Residents must add 8.25% Sales Tax	Tax	______
		TOTAL	______

Buy a BasketMath V3 subscription for your child now!.

Method of payment (U.S. Funds):

[ ] Payment enclosed
[ ] Purchase Order # _______________ (Attach)

Please send this form with your check or money order to

:
Science Academy Software^®
600 Baychester Avenue, Suite 5B
Bronx, NY 10475-4457
(718) 862-4198
U.S.A.

	* A URL, screen name and password will be sent to you by email.
	Email: staff@scienceacademy.com making your Learning Experience FUN!!!

Name	____________________________________
Organization:	____________________________________
Address:	____________________________________
City:	____________________________________
State	____________________Zip:_____________
Email:	____________________________________

_______________ DATE:	Requested Activation Date (subscriptions only). If you do not provide one, we will assign one to you. Please allow for a reasonable mail order processing time.