Publication Order Form

Quantity                         Description                                               Regular Price*  

   #10401  The Guide - SSDI, SSI, and Work Incentives                     $ 68.00          

   #10402   Special - Two copies of The Guide                                           $110.00             

   #10403   Managing Your SSDI Benefit and Income Handbook           $ 12.00                 

   #10404   Managing Your SSI Benefit and Income Handbook                 $ 12. 00                   

   #10405   Four Handbooks, two #10403 and two #10404                          $ 40.00       

   #10406   SPECIAL - 4 copies each - #10401, 10403 & 10404         $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)

If you pay by check, the payment should be sent after you have submitted this order.  If you wish to pay by credit card, please

indicate the card type below.  We charge credit cards when the order is ready for shipment.

Credit Card Payment: 

Type of Card   Visa     Mastercard    American Express

Card Number   Expiration Date Name on Card 

Invoice Agency:

  Please invoice our organization (Orders of $45 or more).   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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