ERI Order Form

Please provide this information via postal mail or FAX only. This form cannot be submitted through the web and it should not be submitted by e-mail either.

Do not forget to complete the form before printing or faxing.

Please select a product below:

1001 Distance Learning Program	US$ 2,395 + shipping
1001 Reference Edition Material	US$ 1,395 + shipping
"Random Vibration and Shock Testing" Book	US$ 250 + shipping (*)
Basic series in Vibration and Acoustics (6-hour DVD set)	US$ 850 + shipping
Combo 1 - Distance Learning Program + Text Book	US$ 2,595 + shipping
Combo 2 - Reference Edition Material + Text Book	US$ 1,595 + shipping

() California residents, please add local sales tax (7.25%) to your order.*

Personal Information: Family Name
Personal Name
Organization
Website
Postal Address
Telephone Extension Fax
E-mail

Shipping Information:

Priority	2nd day	Ground	Other
Carrier / Shipping Account:
Destination:		Business	Residential

Shipping Address (if different from above): Full Name
Organization
Postal Address
Telephone Extension Fax

Payment

Please check below your preference:

Visa

Mastercard

Check

Other

Total (US$):
Credit Card Number Expiration Date
Name as it appears on card:

To complete your purchase:

Print this form and FAX it to (805) 966-7875
Or
Print this form and mail to ERI: 1520 Santa Rosa Avenue, Santa Barbara, CA 93109, USA.

ERI Order Form

Thanks for your purchase! Please note that products won't be shipped until funds reach ERI (Equipment Reliability Institute).