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Products
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Shop
About Us
Careers
Support
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Terms and Conditions of Sale
New Account Form
Privacy Statement
Out of Print
Student Data Files
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New Account Form
Legal/Trade Name :
Billing Address
Billing Address
Street Number and Name :
City :
State/Province :
Zip/Postal Code :
Contact Name :
Phone # :
Fax # :
Email :
Shipping Address (if different than Billing)
Shipping Address
(if different than Billing)
Street Number and Name :
City :
State/Province :
Zip/Postal Code :
Contact Name :
Phone # :
Fax # :
Email :
Accounting and Payment Information
A/P Contact
Market Segment: (please choose)
HED
Business
K-12
Workforce Development
Phone #
Fax :
E-mail:
Requested Terms: (please choose)
Credit Card
Net-30
Trade References may be requested
Federal ID
Tax Exempt #
AGREEMENT FOR CREDIT SALES:
The above information is for the purpose of obtaining credit and is warranted to be true. I hereby agree to pay all invoices within 30 days of receipt of invoice or as expressly agreed. Interest of 2% may be charged on overdue invoices. I hereby authorize CCI Learning Solutions Inc. to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account.
I agree to agreement written above
Authorized Applicant:
Title:
Date: