Teachnology Gold Membership Offline Site License Sign-up Form

Note: All information provided on this form is kept in strict confidence. Printable Version

1. Contact Information

Name _________________________ School or Organization Name: ___________________________

Street Address: ______________________________________________________________________

City:____________________________________ State: _____________ ZIP Code: _______________

Country: ________________________ E-mail Address: _____________________________________

Daytime Phone: __________________________________ Fax: ______________________________

2. Billing Information

Purchase Order / Check #:____________________________________________________________

Date Authorization Issued: ____________________________________________________________

Authorized Name: ________________________________ Title: ______________________________

3. Choose # of Staff Members Included With License ( Prices are in U.S. Dollars)

______ 13 - 25 Teachers: Grants one year of access to 13 - 25 Teachers. $350.

______ 26 - 50 Teachers: Grants one year of access to 26 - 50 Teachers. $500.

______ 51 - 75 Teachers: Grants one year of access to 51-75 Teachers. $650.

______ 76 - 100 Teachers: Grants one year of access to 76-100 Teachers. $750.

4. Licensing Agreement

All materials can be used and photocopied for classroom use only. Our products cannot be used for commerical means.

Signature: X_______________________________________________

5. Submitting Order

In order to finalize the order:

  1. Choose an email address that will serve as the Username for this account: _______________

  2. Choose a password for this account: _________________

  3. Mail purchase order, check, money order, or credit card information to:

Teachnology, Inc.
Attention: Getworksheet.com
PO Box 1107
Truro, MA 02666
USA

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