Synergy Learning - Connect: Subscription Order Form

I'd like to subscribe

Step 1: Enter your order, contact and shipping information
             Print and mail page if paying by check or P.O.

Step 2: Confirm order information

Step 3: Arrange payment via credit card or your Paypal account.
             Paypal is our secure credit card processor.

First Name:
Last Name:
Organization:
Address:

City:	State: Zip:
Country:
Phone:
*E-mail:**
	* This is the address that will be used for order confirmation and delivery of Connect

What issue shall we begin your subscription with:

	Quantity	Unit Price	Total
1-year subscription to Connect		$20.00
	Total Amount Due:

Click on the 'Next' button to submit your order and
pay by credit card.

-or-

Print out this completed order form and mail with your check or school purchase order to:: Synergy Learning; PO Box 60; Brattleboro, VT 05302