Credit Card Order Form
2008 Impulse Survey of Focus Facilities

The price includes the spiral-bound printed copy of the book
as well as online access to facility ratings.

  • Price: US$85 + shipping & handling; Additional S&H outside of U.S.
    Additional books to same address: US$65 + S&H; Additional S&H outside U.S.

    Moderators who rated:
       6-10 facilities: US$65 + S&H; Additional S&H outside U.S.
       11-16 facilities: US$45 + S&H; Additional S&H outside U.S.
       17+ facilities: US$25 + S&H; Additional S&H outside U.S.

  • All orders shipped to California addresses will include 8.25% sales tax.

    No FedEx shipping, even with your own account

  Order Online:

1. Enter Quantity  

2. Contact Information
First Name: Last:
Title:
Company:
Address:
City: Country:
State/Province: Zip Code/Postal Code:
Phone: Fax:
Email Address:

 

3. Shipping Information
- Choose from the following:
US ONLY

Postal Media mail: $5 (8 days) + $3 each addtl book

UPS Ground: $11 + $5 each addtl book

UPS Next Day air: $55 + $10 each addtl book

INTERNATIONAL

Global International Mail $15 per book

No FedEx shipping, even with your own account

 

4. Moderator Discount
Moderators who rated 6 or more facilities by February 15, 2008 are eligible for a discount.
For moderator discount, enter your email and password (same email address and password you used to rate the facilities):
Email:
Password

 

5. Credit Card Information
American Express, VISA, MasterCard and Eurocard
Card Number: Expiration: /
Name on card:   SSL Certificate Authority
V-Code:  
For fraud protection, please enter your V-Code -- the 4 numbers above the credit card number
on the front of your AmEx; or the 3 numbers on the back of your Visa, Eurocard or MasterCard,
immediately following your account number.