Publication Order Form

Quantity                                    Description                                                           Price       

   #08401  The Guide - SSDI, SSI, and Work Incentives                        $ 68.00               

   #08402   Special - Two copies of The Guide                                     $110.00       

   #08403   Managing Your SSDI Benefit and Income Handbook           $ 12.00           

   #08404   Managing Your SSI Benefit and Income Handbook              $ 12.00      

   #08405   Four Handbooks, two #08403 and two #08404                    $ 40.00              

   #08406   SPECIAL - 4 copies each - #08401, 08403 & 08404      $250.00        

* There is a $5.00 Shipping Charge for each order (regardless of the size of the order).

Name:       Title: 

Agency:

Street:   

City:         State:    Zip:

Telephone (area code & number) :

Fax   (area code & number) :           

E-mail Address: 

                                                      Method of Payment

                                  (Payment must accompany orders of less than $45.00)

Credit Card     

          Type of Card   Visa     Mastercard    American Express

       Number:       Expiration Date (M/Y) 

Invoice Agency

  Please invoice our organization.   Purchase order #

Ship to: (if different from above)

If you wish to order by mail or by fax - highlight and print this page.

Mail Order To:   Benefits Training and Consulting

                              P.O. Box 40,  Oxford, PA  19363

Fax Order To:  (610) 932-0428                

Make check payable to Benefits Training and Consulting

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