EPES TESTING, INC.

**CUSTOMIZED SURVEY QUESTIONNAIRE SERVICES** ORDER FORM

Download this form in Adobe Acrobat Format!
You can download a sample in Adobe Acrobat format for any
test below by double clicking the underlined order number.
ORDER NUMBER
 TESTS/GRADE SETS/SCORING SERVICES*
UNIT PRICE
QUANTITY
TOTAL PRICE
7305
 Customized Survey Questionnaire -up to 2500 sheets per box (Customized to your needs) up to 100 lines
$50.00
7306
 SCANNABLE QUESTIONNAIRES (up to 100 lines) (Includes scan forms with all customized statements and directions PLUS FREE TOTAL REPORT)
25¢/ea
7307
 NON-SCANNABLE QUESTIONNAIRES, KEYBOARDED At 1¢ per question per questionnaire, i.e., 35 questions = 35¢ per questionnaire (minimum 35¢/ea) Number Questions x 1¢ =
_____/ea
DEMOGRAPHIC REPORTS
  You can order a wide variety of additional reports.
Examples of reports you can order from the
demographic information are:

1-Each school, i.e., Johnson Elementary
2-Each grade, i.e., Grade 1 Respondents, Grade 2, etc.
3-All of one grade in district
4-Male            Black
   Female         White
                       Hispanic
                       Other

or

you can have a combination of three demographics, such
as Black Females at Johnson Elementary

Check with us on the possibilities!
$2.00/ea 
SUBTOTAL
9999
 SHIPPING AND HANDLING - 10% per shipment (minimum $15 per box) EXCEPT AK, HI, and outside U.S., add actual shipping charges
TOTAL

Purchase Order #:___________________________
(School systems may submit a purchase order when ordering. All other orders need to be prepaid.)


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

Bill to(if different):
Name
Position
Address
City
State
Zip
Print this Order Form out and mail(or FAX) to:

EPES Testing, Inc.
606 Peach St.
Magnolia, AR 71753

 

Questions? See our Faq

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

Email EPES