TRAYCARE ORDER FORM
 (Print and submit with payment) or order on-line

For multiple orders, attach a list of shipping addresses as applicable

 

Name:____________________________________________________________

Street Address:____________________________________________________

City:_____________________________________________________________

State: _______________________________Zip:__________________________

Phone: Day: (          )________________________________________________

Fax:              (          )________________________________________________

 

Program Cost:

1 TRAYCARE Program - $695.00 + S&H

2-5 Programs               - $670.00 each + S&H

6 or More Programs     - $650.00 each         

Shipping & Handling: 
- 1 Program - $7.50

     - 2-5 Programs - $5.00 each

          - 6 or More - Free

 

¨ 

Copies Ordered:

___________
 

Times
Cost per Copy

___________
Total Program Cost:

___________
Shipping and Handling Cost:

___________
Total:

___________

 

Make Check or Money Order Payable to:

Simmons & Associates

P.O. Drawer 152

Tylertown, MS  39667

 

PROGRAM REQUIREMENTS:

Windows XP (Home, Business or Professional)

MS Office Access 2003

Windows Printer  (Black & White or Color)

No Internet access required

Recommend 512 MB memory,  80 GB hard drive