Power HItter® Order Form

Product Order Form

Power Hitter Products Order Form

First Name: 

Last Name: 

Middle Initial: 

Street Address: 

Street Address 2 (Optional)

City: 

State: 

Zip Code: 

Phone Number: 

Email Address:  


Shipping Address: (If different from above)

First Name: 

Last Name: 

Middle Initial: 

Street Address: 

Street Address 2 (Optional)

City: 

State: 

Zip Code:  

Please check all that apply:

   

After School


Summer Program


Tutoring Support

 


Self-Contained Class



Subject area enrichment



Special Education


Additional Information:

School (Specify): 

District: 

Home School: 

Grade Level(s): 

Subject Area(s):  

   

Description: (ex. Math Booklet 1)


ISBN Number: (ex. ISBN-0-9704010--5-8)


Quantity:

 

Billing Information:

Credit Card #: 

Expiration Date: 

Security Code: 

Name on Card:  

Signature:   

*Signed purchase order form and school billing authorization required! 

Purchase Order Number

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