E.L. Achieve Order Form

	A	B	C	D	E	F	I	J	K	L	M	N	O	P	Q	R	S	T	U
1	E.L. Achieve Order Form
2	Please complete this form and share your Google Sheet with us or send a scanned PDF:
3	Fax:	831.536.1616			Email:	orders@elachieve.org
4	Customer Information:
5	Name											Title
6	Agency											Phone
7	Street
8	City											State					Zip
9	Email
10	Shipping Information, if different from above:
11	Name											Title
12	Agency											Phone
13	Street
14	City											State					Zip
15	Email
16		Receiving location is closed for break. Please enter date range of closure:														–
17	Payment Method:
18		Request an Estimate*						Check Number:
19		Credit Card Payment*						Purchase Order Number:
20	*Client Services will contact anyone requesting estimates and/or credit card payments.
21	Request for Additional Information:
22		I am interested in learning about E.L. Achieve’s professional development.
23		I would like to receive periodic updates from E.L. Achieve.
24	Email(s):
25	Institute Information, required for all partner district Handbook orders:
26	Lead Presenter
27	Co-Presenter(s)
28	Institute initiative:
29		ElemELD				SecELD		ElemCM				SecCM
30	Will this institute be offered virtually?
31		Yes				No
32	Institute dates:
33	Day 1				Day 2		Day 3				Day 4				Day 5
34
35
36		Apprentice Institute
37	Apprentice(s)			1				2						3
38
39	Order Summary
40
41		$0.00				Publicly Available Products Subtotal (tab 2)
42		$0.00				Partner District Products Subtotal (tab 3)						>	For international, AK, and HI orders, please call or
43		$0.00				eLearning Products Subtotal (tab 4)							email for a quote on shipping/handling charges.
44		$0.00				Materials (tab 5)
45	+	$0.00				Presenter Kits (tab 6)						>	Distributor charges 15% re-stocking fee on all
46		$0.00				Product Subtotal							returned items.
47	+	$0.00				Shipping & Handling (10% of product subtotal)
48		$0.00				Subtotal						>	Reference the website for product descriptions:
49	x	0.00%				Enter CA & WA Resident Sales Tax, or 0							www.elachieve.org/products
50		$0.00				Calculated Sales Tax
51	=	$0.00				Grand Total
52
53	Internal Use Only
54	SO #							EST #
55			VISTA							EST SENT									DL
56			HAYS																WEB
57			CL					INV #
58			LOG							INV SENT
59			DC							INV PAID
60	Notes
61
62	760.290.3461								www.elachieve.org									orders@elachieve.org