To place your order, you can ORDER ON-LINE   Secured by AShopCart 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 Phone: 570-629-7094                            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  ______ (Select this format if you do not have MS Word on your computer.)                                                                                                                                                                                                                                                                                                            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-$389.00 _____                                   ISO 9001 Quality Manual for Software Developers-$299.00 _____                 ISO 13485 Quality Manual-$499.00 _____                                                ISO/IEC 17025 Quality Manual-$399.00 _____ ISO/TS 16949 Quality Manual-$399.00 _____ ISO 22000 Food Safety Management System Manual-$399.00 _____ ISO Internal Auditor Training for Small Business Kit-$149.00 _____ New Product Development and Introduction Manual - Volume 1-$249.00 _____ New Product Development and Introduction Manual - Volume-$199.00 _____ New Product Development and Introduction Manual (complete package)-$399.00 _____ Supplier Certification and Management Program-$269.00 _____ Supplier Evaluation Kit-$89.00 _____ Sales tax-6% (PA only) _____ Shipping & Handling-$10.00) _____ Total (with order) _____                                                                                                                    Payment: Orders from outside the US must be prepaid in US dollars, credit card, check or money order, or bank wire transfer. 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 #: ___________________ BANK WIRE TRANSFER:  _____ (Check here and, we will send you the applicable bank information.)  Delivery: Please allow 1 week for delivery in the United States and Canada.
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