Student Reader Order
Ordered By
Date
Name
Phone Number
Email Address
I will
Pick-Up
Reader at the
Downtown Hayward Location
Book Mail
Reader to:
Your card will be charged
an additional $5.00
Street Address
City, State, Zip
Please enter Instructor, Course Name & Reader Number
Credit Card Information
Visa
MasterCard
American Express
Credit Card Number
Exp. Date
CVV
Code
By submitting this form you are giving us permission to charge your
credit card for the amount of the reader you are purchasing plus
9.75% tax and/or add'l shipping fees.
Please allow 1-2 working days for Pick-Up and 3-4 working days for Book Mail.
1090 B Street, Hayward, CA 94541 | Phone: (510) 886-4443 | Fax: (510) 886-3044 | hayward@copypacific.com
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