23rd Edition Clinical Procedure Manual Order Form

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Please complete the information below to place an order for a printed version of the manual.

Organization

Your First Name:

Your Last Name:

Your Email:

Your Phone:

Shipping Address:

Please provide the name and address your order should be shipped to.

Attention

Shipping Street

Shipping Suite/Apt/Unit

Shipping City

Shipping State

Shipping Zip

Rate and Quantity:

Select your rate:

LeadingAge Member ($1,999 / manual)Non-Member ($2,599 / manual)

Please note: LeadingAge Membership will be verified after form submission and charges adjusted based on eligibility.

Quantity:

Quantities of 5 or more are eligible for a 10% bulk discount off the selected rate.

Final Amount:

Coupon Code:

Payment amount authorized (USD):

Payment Details

Please provide your card information and billing address below.

Payment Options

Credit CardCheck or ACH (order will be processed once payment is receieved)

Payment Information: Credit Card

Name on Card:

Card Number:

Security Code:

Expiration:

YYYY

Billing Confirmation Email

Payment Information: Card Billing Address

Street

Suite/Apt/Unit

City

State

Zip

Payment Information: Check or ACH

To pay by check or ACH, please review the payment information in the LeadingAge CPM Payment Instructions (ACH, Wiring, Check) PDF and submit your order below. Orders paid by Check or ACH will be processed once payment is received.

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