1. Contact Information

Name _________________________ School or Organization Name: ___________________________

Street Address: ______________________________________________________________________

City:____________________________________ State: _____________ ZIP Code: _______________

Country: ________________________ E-mail Address: _____________________________________

Daytime Phone: __________________________________ Fax: ______________________________

2. Billing Information

Purchase Order / Check #:____________________________________________________________

Date Authorization Issued: ____________________________________________________________

Authorized Name: ________________________________ Title: ______________________________

3. Choose License ( Prices are in U.S. Dollars)

______ School Building Site License: Grants one year of access to all staff within a bulding.
$250.00 per school bulding

______ School District Site License: Grants one year of access to all staff within a district.
$400.00 per school district

4. Licensing Agreement

All materials can be used and photocopied for classroom use only. Our products cannot be used for commerical means.

Signature: X_______________________________________________

5. Submitting Order

In order to finalize the order:

1. Create a list of authorized user email addresses and passwords. Each teacher or department should have it's own account. Compile a list of all of the accounts you would like created.
2. Email the list to orders@makeworksheets.com.
3. Mail purchase order, check, money order, or credit card information to:

Teachnology, Inc.
Attention: Makeworksheet.com
21 Ridge Road
Croton-on-Hudson, NY 10520
USA