Note: this is not an online form. Cut and paste this to your word processor to fill in and either e-mail it or send by US postal service.

e-mail to nrcgsh@rit.edu or mail to:

EASI
PO Box 18928
Rochester NY 14618

Name

e-mail

Address to send materials to:

Name of school or company

Street Address

City, state, country and Zip

Put an x in front of the items you are ordering:

-Adaptive Computing Video and Resource Guide $30

-Access to Math and Graphics video and manual $30

-Teacher Attitudes and Lab Access video and manual $30

Note: The set of three is $75

How You Will Make Payment

Payment amount

EASI's PAYMENT INSTRUCTIONS

Payment should be made to the TLT Group,
The TLT Group federal id number is 52-2063255.

1. You may send a purchase order or invoice request to either:

EASI
+ P.O. Box 18928
Rochester, NY 14618

E-mail: nrcgsh@rit.edu

2. Credit Card Payment

PLEASE INDICATE MASTERCARD OR VISA

You must include the following information

Name on Credit Card

Credit Card Number

Expiration date

A real signature

3. Please make sure that you have your name and email address included on your check.

If you have any questions about registration, contact: EASI at (716) 244-9065 or nrcgsh@rit.edu