Version XVI
ACADEMIC ORDER FORM		 Instructions:
1. Select the desired products.
2. Fill in your personal information.
3. Print the form.
4. Enter your credit card information.
5. Fax the form to 1-540-428-0089.

Call 1-800-232-7828 x"0" or 1-540-428-0084 x"0"
between 9am and 5pm ET if you need assistance with ordering.
Location:
NOTE: *Student licenses require proof of academic student status.

Item Duration Language Type License Quantity Unit Price Total
$695.00 $695.00
(where relevant)
Shipping 15.00
Tax
TOTAL $710.00


Ship to: Bill to: (if different than ship to)
Name:
Title:
Organization:
Address:
City:
State:
Country:
Postal code:
E-mail:    
Telephone:  
Fax:

Proof of academic status (all information is required)
Web site address of your degree-granting academic institution:
Your e-mail address at that institution:
Please attach proof of your current academic affiliation, such as a copy of a currently dated identification card, a website URL showing you as a faculty or staff member, a copy of your class schedule, or an invoice from your institution.

Payment method (advance payment required for all orders totaling less than $5,000.00):  
Credit card #: __________________________________ Expiration date: _________________________

Name on card:   Signature (required): ___________________________

*P.O. # (StatPoint may accept P.O.s for orders over $5,000.): ___________________________________

IF CENTURION UPGRADE OR DISCOUNTED COPY OF STATGRAPHICS MOBILE IS ORDERED:
Stat. package:   Version:   Serial #:

NOTE: For competitive upgrade, user must provide proof of ownership of a current Minitab, SAS/JMP, SPSS, StatSoft, or Systat license.
  
Prices shown are effective September 15, 2009 and are subject to change without notice.