Abbott, Langer & Associates - Compensation and Benefits Print Order Form

Abbott, Langer & Associates, Dept. NET, 548 First Street, Crete, IL 60417-9987
phone: 708/672-4200 fax: 708/672-4674
email: mailto:sales@abbott-langer.com

Compensation Survey Report
Print Order Form (for mailing or faxing)

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Yes! I can certainly use this material in my work.
Please RUSH the item(s) listed below to me IMMEDIATELY!

       Publi-
Quan-  cation                                Unit
tity    Code       Item Description          Price
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__ Check Number ____________ for $________ is enclosed
(Illinois residents add 6.5% sales tax)
__Visa   __MasterCard   __AMEX   __Discover
Credit Card Number: ______________________________
Credit Card Expiration Date:______________________
Credit Card CVS code*:____________________________

Shipping Address
----------------

Name:_____________________________________________

email address:____________________________________

Job Title:________________________________________

Employer Name:____________________________________

Street Address of
Employer**:_______________________________________

                                     Zip
City:_____________________State:_____Code:________

Phone                     Fax
number***:________________number:_________________

Credit Card Billing Address (if different from above)
-----------------------------------------------------

Name:_____________________________________________

email address:____________________________________

Job Title:________________________________________

Employer Name:____________________________________

Street Address of
Employer:_________________________________________

                                     Zip
City:_____________________State:_____Code:________

Phone                     Fax
number***:________________number:_________________

* Last 3 digits from back of Visa/MasterCard/Discover. Last 4 digits from the front of AMEX.
** FedEx will not deliver to a P.O. Box number. Please give street address.
*** Please give your Phone Number and email address, in case we have a question
about your order.