QUALITY SYSTEMS INNOVATIONS, INC.

Gaging.com

ORDER FORM

	To place your order, you can ORDER ON-LINE   Secured by Virtual Cart's Secure Sockets Layer (SSL) Security or to order by mail print this form, complete the CUSTOMER INFORMATION section below and mail or fax to: QUALITY SYSTEMS INNOVATIONS, INC. 1 Meadow Drive Effort, PA 18330 USA Fax: 570-629-3750 Email: qsiinc@ptd.net CUSTOMER INFORMATION ____________________________________________________________________________ NAME                                                                                                        ____________________________________________________________________________ TITLE ____________________________________________________________________________ COMPANY ____________________________________________________________________________ STREET ADDRESS (We will not ship to P.O. boxes.) ____________________________________________________________________________ CITY                                                                STATE                        ZIP/POSTAL CODE    ____________________________________________________________________________ COUNTRY ____________________________________________________________________________ PHONE                                                  FAX                                          E-MAIL     Please specify format you require (select one): MS Word   ______                                                                                   Rich Text Format  ______                                                                                                                                                                                                                                                                                                           Please specify item(s) you require:                                                                                                                      QTY                                 ISO 9001 Quality Manual for Manufacturers @ $249.00 _____                                     ISO 9001 Quality Manual for Services  @ $249.00 _____                                   ISO 9001 Quality Manual for Medical Devices  @ $289.00 _____                   ISO 9001 Quality Manual for Software Developers @ $299.00 _____                                                ISO/IEC 17025 Quality Manual @ $399.00 _____ ISO/TS 16949 Quality Manual @ $399.00 _____                        Supplier Certification and Management Program @ $169.00 _____                                                                 Supplier Evaluation Kit@ $69.00 _____ Sales tax (6% PA only) _____ Shipping & Handling (US: $5.00; CANADA: $6.00) _____ Total (with order) _____ Payment: CREDIT CARD INFORMATION: (If paying by credit card) Card Type: _________________________________________________________ Card Number:  ______________________________________________________ Expiration Date:  _____________________________________________________ Name On Card: _____________________________________________________ Street Address:  _____________________________________________________ City: ___________________________________________________  State: _____ Zip/Postal Code: ________________ Country: _____________________________ Signature: _______________________________  Date Signed: ________________ PURCHASE ORDER #: ___________________ Delivery: Please allow 1 week for delivery in the United States and Canada, or circle "Rush Order", and we will send your quality manual via e-mail no later than 8:00 AM EST of the following business day.  The cost of this service is included in the shipping and handling fee.