Science Select Order Form
Science Select
Daily Lessons Plans for 3rd - 4th - 5th Grade
Intermediate Science Teachers
Science Select
70 Shearwater Place
The Woodlands, TX 77381
281-419-4461
FAX 281-292-3730
Bill To (Please Print Clearly)
Name:
 Ship To (Please Print Clearly)
Name:
School:
 Location:
Address:
 Address:
City:
 City:
State:                                Zip:
 State:                                  Zip:
Phone: (     )   
 Phone: (     )
Module #
 Module
Name
 Quantity
(# of Users)
 Price
 Total
Price
         
         
         
         
         
         
         
         
*If no district purchase order is used, a tax exempt number
is required.  Individual tax rate is 8.25%.                                                                                                                   Module Total   ____________
                                                                                                                           Shipping & Handling    ____________
                                                                                                                                                   *Tax      ____________
                                                                                                                                                    Total     ____________
Make check payable to Science Select
_________  Enclosed is my check or money order in U. S. Funds

_________  Enclosed is my purchase order number ___________

Authorized Signature _________________   Title __________________ Date ________