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1
Ship to: (Note: We cannot ship to P.O. Boxes)
Name _________________________________________________________________________
Title
__________________________________________________________________________
Organization
_________________________________________________________________
Street
_________________________________________________________________________
City
______________________________________________ State ________ Zip ________
Phone ( )
_______________________________________________________________
Email
_________________________________________________________________________
(Please use your Q account email above if ordering Q products.)
2
Bill to: (if different)
Name __________________ ________________________________________________
Street __________________________________________________________________
City _______________________________________ State ________ Zip __________
Phone ( ) ________________________________________________________
Email __________________________________________________________________
Ordering Q products? Please identify for what type of account:
New User  Q-global
®
  Q-interactive
®
  Q-Local
™
Q-global account # ____________________________________________________
Q-interactive account #
________________________________________________
Canadiancustomers,pleasecontactourPearsonCanadaoce
to place your order at 866.335.8418.
I authorize Pearson to ship this order and agree to the terms set forth on
the Pearson website, including the terms of the User Acceptance Form, the
Terms & Conditions and the Returns Policy at PearsonAssessments.com.
Authorized Signature ______________________________________________
Title
____________________________________ Date ____________________
* 3-5 DAY: Add 4% to standard shipping price.
shipping price. INTERNATIONAL: Add 10% to standard shipping price. ALASKA, HAWAII,
PUERTO RICO, AND VIRGIN ISLANDS: Add 5% charge to standard shipping price.
6
Authorization
MAIL: Pearson
Clinical Assessment
Ordering Department
P.O. Box 599700
San Antonio, TX 78259
PHONE:
800.627.7271
FAX:
800.232.1223
Order Form 2020
4
Payment (Note: We cannot accept cash)
Purchase Order* # ____________________________________________________________
*If you are submitting a purchase order, please attach it to this completed
order form.
Pearson only accepts credit card payments through its e-commerce portal, call center
and remote call centers at selected Events. Credit Card information is not accepted
via paper order to protect your personal information.
Prices effective from January 1, 2020 to December 31, 2020 and subject to change
without notice. Terms are balance net 30 days, Risk of loss is FOB destination with
shipping charges added to invoice per chart (at right). If prices on your order are
incorrect, we reserve the right to exceed the amount up to 10% unless otherwise
stated on your order. Please see Terms & Conditions at PearsonAssessments.com.
For faster processing, complete the webform at pearsonassessments.com/
submitorder and attach this form along with any purchase orders/quotes.
Select ‘new order’ as your submission category. If yo
ur order is for multiple
products, please type in the name of one product. Then enter information on
your additional product(s) in the paragraph field.
5
Shipping
Standard Shipping
(shipped within 48 hours)
ORDER SIZE CHARGE
< $500 6% (Minimum $10)
$500 to $2499 5%
$2500+ 4%
Subtotal
Standard Order Shipping
Additional Shipping Charges*
(OFFICE USE ONLY) TOTAL $
3
Product Description or attach Purchase Order (PO)
Product Number Quantity Unit Price Total Price
Pearson must
havea copy
of certificate
on file.
Tax Exempt?
Add state and local tax
(OFFICE USE ONLY)
Office Use _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
800.627.7271
|
PearsonAssessments.com
Copyright © 2020 Pearson Education. All rights reserved. Pearson, Q-global, Q-interactive, and Q Local are trademarks,
intheU.S.and/orothercountries,ofPearsonEducation,Inc.oritsaffiliates.CLINA22998EL1/20
Have you ordered from Pearson before?
Yes  No (If first order, please complete Qualification online
at PearsonAssessments.com/Qualification)
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Completed 9 June 2021

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