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SchoolMatch® Information Services Order Form

Please complete and return this form, a narrative (see Page Size below) about your school system and a purchase order or payment to:  

If using a Purchase Order please include a copy.

SchoolMatch
6167 Deeside Drive
Dublin, Ohio 43017
Fax: (614) 764-4709

Contact/Billing Information:

Name:

Title:

Address:


Telephone:

Email:
____________________________________________

____________________________________________

____________________________________________

____________________________________________ Zip: ________-_____

(____)_____-_______

____________________________________________


Type of Payment:
Purchase Order - Number:___________ Check Enclosed - Number:___________

Charge - Please circle one:     VISA    MasterCard    AmEx    Discover

Card Number:___________________________ Exp. Date:___________

Signature:__________________________________________________


Page Size - Please circle one:    
1/3 page for $99.00     2/3 page for $168.00     Full page for $237.00

School/System Information:

School/System Name:

City, State Zip:

______________________________________________

______________________________________________