Print this form, fill out the information, and mail it to:

         Exemplary Center for Reading Instruction
         3310 South 2700 East
         Salt Lake City, Utah 84109
         (801) 486-5083


Name ___________________________________________________________

Address ________________________________________________________

City, State, Zip _______________________________________________

Phone Number _(_______)_________________________


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Name of Item                             Qty    Amount    Total

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

_____________________________________    ___    ______    ______

                                                Total __________

                                 Shipping and/or Tax* __________

                                         Total Amount __________

Check method of payment:

   _____  Visa    _____ MasterCard     _____ Check enclosed

                     Card number: ______________________________

                     Expiration date: _______________

                     Signature: ________________________________


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*Sales Tax is only required if you are a Utah resident.  The tax
rate is 6.35%.

Shipping is computed by multiplying the Total Amount ordered with
the corresponding value from the following table:

    For shipments within the Continental U.S.A.
             $.01-$10..........20%
             $11-$24...........18%
             $25-$500..........16%
             $501-$1,000.......14%
             $1,001-$2,000.....12%
             Over $2,000.......10%

    Shipments to all other locations (Canada, Alaska, Hawaii, 
    etc.) will be invoiced with the materials.


Shipping Policy:

    Materials may be returned within 30 days of date of delivery
    if returned in saleable condition.  Shipments must be send 
    prepaid.  A restocking fee of 15% will be charged.