(EPES Testing Order Form-GA)

EPES TESTING, INC.
ORDER FORM FOR WEST VIRGINIA WESTEST PRACTICE TESTS
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Order Number	Test/Grade Sets/Scoring Services	Unit Price	Quantity	Total Price
1103	GRADE 3 READING TEST	30.00
1203	GRADE 3 MATH TEST	30.00
1130	GRADE 3 TEST SET - BOTH TESTS	ONLY $46
1104	GRADE 4 READING TEST	30.00
1204	GRADE 4 MATH TEST	30.00
1140	GRADE 4 TEST SET - BOTH TESTS	ONLY $46
1105	GRADE 5 READING TEST	30.00
1205	GRADE 5 MATH TEST	30.00
1150	GRADE 5 TEST SET - BOTH TESTS	ONLY $46
1106	GRADE 6 READING TEST	30.00
1206	GRADE 6 MATH TEST	30.00
1160	GRADE 6 TEST SET - BOTH TESTS	ONLY $46
1107	GRADE 7 READING TEST	30.00
1207	GRADE 7 MATH TEST	30.00
1170	GRADE 7 TEST SET - BOTH TESTS	ONLY $46
1108	GRADE 8 READING TEST	30.00
1208	GRADE 8 MATH TEST	30.00
1180	GRADE 8 TEST SET - BOTH TESTS	ONLY $46
1110	GRADE 10 READING TEST	30.00
1210	GRADE 10 MATH TEST	30.00
1190	GRADE 10 TEST SET - BOTH TESTS	ONLY $46
7005	SCAN SCORING SERVICES: Includes customized forms, scoring, plus FREE CLASS REPORT - (Each student per test) -up to 2500 scan sheets per box	.18
7006	ADDITIONAL REPORT SERVICES (available with 7005 or 7007) INDIVIDUAL STUDENT REPORT (Each student per test)	.15
7009	ITEM ANALYSIS REPORTS (Per teacher, per subject)	1.00
7011	CUSTOMIZED CLASSROOM REPORT (Race, Gender, etc.)	1.00
7012	GRADE REPORTS - (Per subject, per grade)	2.50
7013	TITLE I ANALYSIS REPORTS (#174-185) (EACH STUDENT PER TEST)	.15
7014	PROGRESS REPORT (a graph of the same test comparing up to 4 testing dates for 4 teachers)	10.00
90999	SHIPPING AND HANDLING - 10% each shipment (minimum $15 per box) EXCEPT AK, HI, and outside U.S., add actual shipping charges
90994	2ND DAY AIR - actual charges
90990	OVERNIGHT - actual charges
	Total

*Included with every test is a TEACHER SUPPLEMENT including skills measured by each question, the answers to each question, a list of uses of test results, and sample computerized reports if we do your scoring.

Purchase Order #:___________________________

(School systems must submit a purchase order. All others have to be prepaid. Home schools must submit a school address reference with phone number)

Ship to:

Name
Position
School
Street Address
City
State
Zip Code
Telephone (Office)
FAX
Email Address

Bill to (if different):

Name
Position
Address
City
State
Zip

Call toll free 1-800-488-2689 or Fax toll free 1-866-306-7901