Burnham's Insurance Dictionary Order Form

 Burnham's Insurance Dictionary
Price is $295.00
Fee information below		 Use TAB KEY or MOUSE to Navigate this Form


Printable Order form
(PDF to Mail or Fax back)

QUANTITY

DESCRIPTION

 

Your Shipping Information

Shipping & Contact Information
All orders are shipped United Parcel Service (UPS requires a valid street address) or, for additional cost, by US Postal Service.
Ship To:   HOME ADDRESS             COMPANY ADDRESS             OTHER ADDRESS
Full Name:  
Company Name:     (NOTE: Fill this field, ONLY if you are shipping to your company.)

Street Address 1:

  

Street Address 2:

  
City:     State:         Zip:   
E-mail:       (NOTE: Please fill this field carefully.)
Daytime Phone:       Ext:  
Fax:    
Employer:    

How did you hear about us?

 
 
  FEES  
 
Burnham's Insurance Dictionary:
(quantity pricing available)		   $ 295 
UPS Overnight delivery:   $ 45 first dictionary, plus $10 each additional dictionary
UPS Second Day delivery:   $ 25 first dictionary, plus $ 5 each additional dictionary
Standard UPS Ground delivery (allow up to 5 business days):   Free for ALL quantities
 
 
Do you want expedited delivery?       Ground (Free)       2nd Day Air        Next Day Air

  Please click HERE to get the UPS Ground estimate of delivery time to your office.

Billing Information (secure site, but if you prefer, please call us at 1-800-438-2728)
Credit Card
 
    (You must be 'Pre-Authorized' or have an 'Active Account' to be Invoiced.)
Authorization for Invoice:      (If you chose 'Pre-Authorized', then you must fill this field.)
Cardholder name  
Card number              Code:    (last 3 digits, on back.  4 for AmEx, on front)
Expiration date        month/year (ex.: 05/2010)            
Should a copy of the CC receipt be
US Postal mailed to someone else?		   Yes      No
If  'YES,' who?
and what US Postal address?		  

      

Agreement Information (required)

100% GUARANTEE OF SATISFACTION WITH YOUR PROMISE:

Ray's guarantee to you:  The Burnham System offers every patron a guarantee of satisfaction,
or your money back.  If for any reason you are not satisfied with the material you receive,
please return it (along with your suggestions, if you'd be so kind) for a full  and prompt refund. 

IMPORTANT
If you receive a 'FORM FILL ERROR',  please use your browser's ◄◄  BACK BUTTON
to return to this form and make corrections. Otherwise, you will lose all of your entered data.

On normal business days, if you don't receive an automated confirmation within 24-hours,
after submitting this form,  please contact our office by phone, at  1-888-287-6426. 
All processed orders receive confirmation with tracking information,
within 24-hours of ordering (exception: weekends and holidays).

 




The Burnham System
 19 Everett Street
 Southbridge, MA 01550
1-888-BURNHAM
 (1-888-287-6426)

  
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Copyright © 2009 The Burnham System.   All rights reserved.
Revised: 05/29/09