You and Your Orthodontist: Form for Fax or Mail Orders

To Order by Fax or Mail

To order You and Your Orthodontist by fax or by mail, you can either print this page or download a Portable Document Format (PDF) file that contains this form and print that.

Then, fill out the form completely and fax it to (314) 993-6992, or mail it to CAO. (You can also order by voice mail at (888) 242-3934.)

Order Form:

(Please print)

Please send me:
____ You and Your Orthodontist (Informed consent, 2004, in English)

____ You and Your Orthodontist (Informed consent, 1998, in Spanish)

(Minimum order is 50 booklets. There is no maximum. Please order in increments of 50... ;100, 150, 200, ...1000.)

Ship To Address:

Name _____________________________________

Street Address ______________________________
 
City/State/Zip _______________________________

Phone ____________________________________

Fax ______________________________________

Email _____________________________________

Yes, I need a confirmation. Fax or e-mail it to:
__________________________________________

____ Yes, I would like a RUSH (Approximately $15 additional in addition to the regular shipping cost per 100 booklets shipped in the Domestic US.)

Payment Method:

___ MasterCard   ___Visa   ___American Express

___Invoice

Card # ___________________________________

Expiration Date _____________

Name as it appears on Card ___________________________________

Billing Address (If different from above) ___________________________________

___________________________________

(For Office Use only: ____ Entered in DB ____ Payment Processed)

Pricing

All versions of You and Your Orthodontist are $125 for each 100 brochures for members and $140 for non-members.

Sales tax is added where applicable.

Minimum order is 50 booklets. There is no maximum.

Please order in increments of 50... 100, 150, 200, ...1000.

Processing and Shipping

Confirmations of Orders

Confirmations are given when requested in a fax order.

Order Processing and Delivery

Orders are processed upon receipt. Delivery takes about 1 week.

Rush Orders

For an additional fee, you can request a RUSH order, which will shorten delivery time to less than a week.

Just indicate that you want a RUSH somewhere in your order.

Overnight Delivery

If you need overnight delivery, please call (888) 242-3934 and ask for the Order Department.

Next: Frequently Asked Questions