IdeaChain US Mail Order Page

Fill in and print out the order form below. Attach payment and mail to: MindPrime, 4547 Baylor Camp Road, Crawford, Texas 76638.

Ground Mail orders may be paid by money order, cashier's check or personal check. Make money order or check payable to MindPrime, Inc. Allow ten working days before shipment on personal check payments. COD not available.

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
Credit Card Number
Expiration Date

2. Order Information

Click the down arrow to see & select Order Options:

Payments include standard shipping and handling (and tax in Texas.)

Payments include standard shipping and handling.

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:

Grade or Work:

Reading Comprehension Level:

Schooling:

HOW YOU HEARD ABOUT MINDPRIME'S IDEACHAIN PROGRAM:
Where (Choose One):

Print and mail with payment to:

MindPrime, Inc.
4547 Baylor Camp Road
Crawford, Texas 76638-2784

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

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