CLU/ChFC/CASL Order Form
The Burnham System Online
Order Form For CLU/ChFC/CASL Courses


Fee information is below

Use TAB KEY or MOUSE to Navigate this Form

Printable Order form
(PDF to Mail/Fax back)

Each Burnham System Course,
Printed and Fully-Bound sells for only $295 #
and comes with our money back guarantee.

STEP-by-STEP Guided Ordering Process (6 EASY STEPS)

   ( # Multiple-order discounts  are automatically applied during order processing.) 
Orders over $995.00, please call for discounts.
 
Step One:  Please indicate the quantity, course, audio interest and exam date.
 

Courses are periodically revised so please indicate when you plan to take your exam.
The choice of 'FIRST QUARTER' would mean Jan-Feb-Mar for the calendar year
 in which these months are next available.
If it is already June in the present calendar year, then 'FIRST QUARTER' refers to the next calendar year.

QUANTITY

DESCRIPTION
(Each Printed & Bound Course is $295.)

  

EXAM DATE
(by Quarter)

 *

 

  

 

 *

 

  

 

 *

 

  

 
Step Two:  Please provide us with CONTACT Information.
 

The Burnham System is sent by United Parcel Service (UPS) to Street Addresses, only. 
Shipping information will be provided by you in Step 4.  Use this area for Contact Information.
First Name      *
Last Name      *
     
Company      (ONLY if this is a Company Ship To Address. Otherwise, blank.)
Street Address      *
Address (cont.)    
City      *
State/Province        *             Zip/Postal Code    *
Country      (Only required if not USA)
Work Phone        *               Ext:    
FAX    
E-mail       *
Job Title    
Employer      (Only required to apply discounts, if available)
    ( * )  Denotes Required Field


Are you a first time customer?      Yes       No
Please tell us how you learned about The Burnham System?

Your Reference  
Step Three:  Please provide us with SHIPPING Information.

Please provide a physical shipping address below.
The Burnham System ships UPS to street addresses only.
We cannot deliver to a PO Box address.
 
UPS Delivery to your home typically takes one or two days longer than delivery to your office.
  Please click HERE to get the UPS Ground estimate of delivery time to your office.
 

Ship To Company Name
(use to send to your workplace)

      (OPTIONAL, Can be overwritten to change from use of address above .)  

Ship To Name

       (Overwwrite, if NAME is different from above)  

Street Address

      (Overwwrite, if ADDRESS is different from above)  

Address (cont.)

      

City

       (Overwwrite, if CITY is different from above)  

State/Province

            Zip/Postal Code    (Overwwrite, if STATE and ZIP is different from above)  

Country

       (ONLY required if not the USA)  
 
Step Four:  Please provide a UPS Shipping Method.
 

Ground is FREE,  UPS Next Day is $45  and  UPS 2-Day is $25.

 *                                                            *
 
Step Five:  Please provide us with BILLING Information.
Please choose a method      * (If you choose 'Pre-authorized Invoice' please complete Invoice Authorization field.)

(Invoice Authorization)

     (We cannot process your order, if you choose 'Pre-authorized' and leave blank.)
Name as it appears on card    
Organization Name
 (if applicable)		    
Account number        ( "Secure Field" Enter numbers VERY CAREFULLY, Dashes are OK ! )
Expiration date    

Code number (PIN)

  

           Note:  Amex has a 4 digit number on front of card above your card number.
   Other card codes are located on the back above and to the right of your signature.
Other card codes are three digits, sometimes preceded by the last four numbers of you card.

Should a copy of the CC receipt be US-mailed to someone else?

     Yes      No

If 'YES,' then to whom
and to where?

    
 

Do you have any questions
or comments for Ray?
(Ray responds personally
to all requests, quickly.)

    
 

     

100% GUARANTEE OF SATISFACTION AND PASSING
WITH YOUR PROMISE

Ray's guarantee to you:  The Burnham System offers every client 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 email The Burnham System, 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 you send 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.
 
Step Six (last step):  Please read and AGREE TO TERMS and SUBMIT your order.


 

      

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)
Copyright © 2008 The Burnham System.   All rights reserved.

Revised: 05/02/08