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
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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