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Inventory for Client and Agency Planning ICAP Riverside and Compuscore are registered trademarks or trademarks of Houghton Mifflin Harcourt Publishing Company. Page 1 of 1 2013 Inventory for Client and Agency Planning ICAP Order Form Date / / Payment Information Please enclose a check money order or valid purchase order with all orders. Purchase Order enclosed* Number NOTE rders from first time purchasers require a completed O Test Purchaser Qualification Form* Professional Credentials Check enclosed* Number Choose One Money Order enclosed* IMPORTANT NOTE FOR CREDIT CARD USERS For your security we can only accept credit card orders through our secure website riversidepublishing. com or by phone at 800. 323. 9540. Exempt from state sales tax. Please attach copy of certificate Licensed In area State License Expiration Date Member of professional organizations Circle all that apply. Cert. no. ACA AERA AMA APA ASHA CEC Cert. Expiration Date NASP NCME Other Charge to See note above Ship to Name Position Organization Billing Address if different from billing address Shipping Address City State Zip Phone Fax Email address Item and Packaging Code Number Quantity Catalog Price Total Price I CAP Complete Program Includes Examiner s Manual and 25 Response Booklets Y21-922892 216. 50 Pkg. 25 Response Booklets 83. 50 Spanish ICAP Complete Kit Includes English Examiner s Manual and 25 Spanish Response Booklets Y21-922157 Pkg. 25 Spanish Response Booklets Compuscore for the ICAP Microsoft Windows Version 2. 1 CD-ROM Y21-922884 369. 00 Order Subtotal State Sales Tax Shipping Service Fee Order Total A 10 10. 00 minimum for ground shipping 15 10. 00 minimum for Second Day Air and shipping to AK and HI 17 20. 00 minimum for Next Day Air shipping and 25 for international shipments. Ground transportation available for AK and HI upon request. Prices are valid until December 31 2013 and are subject to change without notice. 3800 Golf Road Suite 200 Rolling Meadows IL 60008 F 630. 467. 7192 Windows and Microsoft are registered trademarks of Microsoft Corporation in the United States and/or other countries. Houghton Mifflin Harcourt Publishing Company. All rights reserved* Printed in the U*S*A. 01/13 MS65540 hmhco. Purchase Order enclosed* Number NOTE rders from first time purchasers require a completed O Test Purchaser Qualification Form* Professional Credentials Check enclosed* Number Choose One Money Order enclosed* IMPORTANT NOTE FOR CREDIT CARD USERS For your security we can only accept credit card orders through our secure website riversidepublishing. com or by phone at 800. 323. 9540. Exempt from state sales tax. Please attach copy of certificate Licensed In area State License Expiration Date Member of professional organizations Circle all that apply. com or by phone at 800. 323. 9540. Exempt from state sales tax. Please attach copy of certificate Licensed In area State License Expiration Date Member of professional organizations Circle all that apply. Cert. no. ACA AERA AMA APA ASHA CEC Cert. Expiration Date NASP NCME Other Charge to See note above Ship to Name Position Organization Billing Address if different from billing address Shipping Address City State Zip Phone Fax Email address Item and Packaging Code Number Quantity Catalog Price Total Price I CAP Complete Program Includes Examiner s Manual and 25 Response Booklets Y21-922892 216.