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CIC Order Form
The Burnham System Order Form For CIC Courses


Fee information is below Use TAB KEY or MOUSE to Navigate this Form

Printable Order form
(PDF to Mail or Fax back)

YOUR INFORMATION

Shipping & Contact Information
(All orders are shipped UPS (requires street address) or US Postal Service (priority mail).
Ship To:   HOME ADDRESS             COMPANY ADDRESS             OTHER ADDRESS
Name:  
Company:    (NOTE: Company name will only be used, if you are shipping here.)

Street Address 1:

  

Street Address 2:

  
City:     State:         Zip: 
E-mail:  
Daytime Phone:      Ext:  
Fax:  
Employer:     (Required to apply any applicable discounts)

How did you hear about us?

 
CHOOSE A COURSE

I want The Burnham System for the following CIC Institute(s)

 
Is this the first time you have used The Burnham System?

Yes              No

 
I am taking my CIC Institute in 

  (State)                       /  (Month)                        (Year).
If you are ordering over $995, you deserve a discount! 
Call us now at 1-888-BURNHAM to find out how much you can save.
  FEES  
 
Any one CIC Part:   $ 295 
UPS Overnight delivery:   $ 45
UPS Second Day delivery:   $ 25
Standard UPS Ground delivery (allow up to 5 business days):   Free
 
 
Do you want expedited delivery?       Ground (Free)       2nd Day Air ($25)        Next Day Air ($45)

  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-mailed to someone else?   Yes      No
If 'YES,' who?
And where do you want us to mail it to by the US Postal Service?		  

      

Agreement Information (required)

100% GUARANTEE OF SATISFACTION AND PASSING
WITH YOUR PROMISE

Ray's guarantee to you:  The Burnham System offers every patron a guarantee of satisfaction and
a guarantee of passing, 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), prior to your exam, for a full refund. 
If you score a non-pass on your exam, please fax or mail your grade results
for a full, prompt refund.

Your promise to Ray:  I promise never to let anyone else, ever, use the material sent to me.  
I promise never to copy or to share the material without Ray's permission. 
I understand Ray's guarantees. 
Our industry is built on the value of our promises. 
I will keep my promise.

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 © 2007 The Burnham System.   All rights reserved.
Revised: 05/08/08