ORDER FORM
QTY DESCRIPTION

COST
_____ $15.00 per Lesson-Game

__________
_____ $60.00 - Five Lesson-Games (One free game)

__________
_____ $345 - Set of 30 Lesson-Games (Seven free games)

__________
TOTAL COST

$ __________
 
ORDERED BY:     SHIP TO:  (If DIFFERENT ADDRESS THAN AT LEFT)
___________________________________
NAME as it appears on the card		 ___________________________________
NAME
___________________________________
ADDRESS		 ___________________________________
ADDRESS
_____________ ___ ______ ___________
CITY, STATE COUNTRY, ZIP/POSTAL CODE		 ___________________________________
ADD'L ADDRESS
(____) _____________________________
PHONE 		_____________ ___ ______ ___________
CITY, STATE, COUNTRY, ZIP/POSTAL CODE
(____) _____________________________
FAX		 (____) _____________________________
PHONE
_________________________________________________________________________
EMAIL
...
CREDIT CARD TYPE: [ ] Visa    [ ] MasterCard     BILLING ADDRESS:(If different than card)
CARD NUMBER: _____________________     ___________________________________
ADDRESS
____________________________________
SIGNATURE 		________________ ___ ______ ________
CITY, STATE, COUNTRY, ZIP/POSTAL CODE

Sign on line above for credit card orders or enclose check payable to: Total Reading

EXPIRATION DATE: __ __ / __ __
  
Mail to: Total Reading
Box 54465
Los Angeles, CA 90054		 For credit card orders, fax to:
310-257-8482. 
Call 800-358-7323 for
school purchase orders.