Energy Source Order Form Bill To: Name:
Company/Organization: Contact:
Address:
City:
State:
Zip:
Phone:
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Name:
Company/Organization: Contact: Address: City: State: Zip: Phone Number: Purchase Order (Schools and agencies only) (check one): Enclosed To Be Sent Not Required Number (If known): Imprinting (check one): Requested Need Information Not Requested Item: Offalot (Kindergarten): Description of materials Student Pack (resupply pack) Unit Price: $15 No. of Student Packs Ordered: Extended Price: Class Set Unit Price: $55 No. of Class Sets Ordered: Extended Price: Energy Elves (Grade 1 or 2): Description of materials Student Pack (resupply pack) Unit Price: $25 No. of Student Packs Ordered: Extended Price: Class Set Unit Price: $55 No. of Class Sets Ordered: Extended Price: Energy Explorers (Grade 3 or 4): Description of materials Student Pack (resupply pack) Unit Price: $30 No. of Student Packs Ordered: Extended Price: Class Set Unit Price: $55 No. of Class Sets Ordered: Extended Price: People Power (Grade 5 or 6): Description of materials Student Pack (resupply pack) Unit Price: $30 No. of Student Packs Ordered: Extended Price: Class Set Unit Price: $55 No. of Class Sets Ordered: Extended Price: Materials Total: Total Price of all materials: Note: The costs for shipping, and, if applicable, imprinting and sales tax (California only) will be added when invoiced. Payment Method: Check Enclosed (Make checks payable and mail this form to address below) Educational Development Specialists 5318 E. 2nd Street, #512 Long Beach, CA 90803 (562)434-6225 phone Purchase Order (Fax or submit this form) (562)434-7551 fax