To place a FAX order for IDEACHAIN:

Fill out the fields, below, then print and fax to 254-845-4700.

For questions regarding privacy, shiping and company policies please refer to the Company Policies page.

1.  Shipping and Billing Information
(All information required so that we can process your order.)

First Name:
Last Name:
Email Address:
Shipping Address:
City:
State/Province:
Country:	United States International (please specify)
Zip/Postal Code:
Phone Number
Credit Card Type	Choose One Visa Mastercard Discover
Credit Card Number
Expiration Date

2.  Order Information

Click the down arrow to see & select Order Options:	United States - click to select option ----> US (other than TX) - 1 Payment: $312.00 US (other than TX) - 3 Payments: 1st@$125.00 - 2@$99.00 US (Texas) - 1 Payment: $337.74 US (Texas) - 3 Payments: 1st@$135.31 - 2@$107.17 Payments include standard shipping and handling (and tax in Texas.)
	Canada - click to select option ----> Canada - 1 Payment (US$): $344.00 Canada - 3 Payments (US$): 1st@$147.00 - 2@$104.00 Payments include standard shipping and handling.
	International - click to select ----> International - 1 Payment (US$): $361.00 Payment includes standard shipping and handling to Canada, Europe, South America, Australia, Thailand and Hong Kong.
	If you have a promotional code, please enter it here. If you were referred by someone, please enter their name here.
Delivery Type:
		Standard Delivery (included) Overnight Delivery (FedEx Standard Overnight) (US $60.00 additional) (Canada $80.00 additional)

 

 

 

 

 

 

 

 

 

 

 

Periodically we send email to our customers notifying them of new products and promotions.
Mark this box if you do NOT want MindPrime to send you update email.

3.  Additional Information

Would you help us with some additional information? How you heard about us and a sketch of who will be using the progam helps us in our efforts to constantly improve our product and services.

IDEACHAIN WILL BE USED FOR THE FOLLOWING INDIVIDUAL:
Male
Female

Age:
Choose One 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20-29 30-39 40-49 50+

Grade or Work:
Choose One 1 2 3 4 5 6 7 8 9 10 11 12 College/University Working

Reading Comprehension Level:
Choose One 1 2 3 4 5 6 7 8 9 10 11 12

Schooling:
Choose One Public Private Homeschool College/University Out of School

HOW YOU HEARD ABOUT MINDPRIME'S IDEACHAIN PROGRAM:
Where (Choose One):
Search on Google Search on Yahoo Search on AOL Search on MSN Search on other search engine From friend From teacher/counselor/principal From speech therapist From educational psychologist From online newsgroup or bulletin board From blog Link from another website Newsletter that was forwarded to me Perspectives Magazine - International Dyslexia Association Newsbriefs - Learning Disabilities Association Attention Magazine - CHADD Family Times Magazine Home Education Magazine Conference, homeschool Conference, other than homeschool Homeschool organization Radio talk show TV appearance Ad online Ad in mail (direct mail) Ad on radio Ad on TV Received email Classified ad Curriculum fair Yellow Pages Other Do not remember

Print and fax to MindPrime at 254-845-4700.

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