Name ____________________________________________________________
Address __________________________________________________________
(No PO Box)
City ________________________ State _________ Zip ____________
Credit Card No. ______________________________ Exp. Date _________
Phone _____________________Email__________________________________
Email address required if you want to take the exam online.
Signature ________________________________________________________
Phone number and signature required for all credit card purchases.
CPA State and Deadline ____________________________________________
Course No. Course Title Qty Price Total
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Shipping and Handling $ ____________
Subtotal $ ____________
TX Sales Tax 8.25% $ ____________
(if applicable)
Total $ ____________
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1. Call (877)7CPENOW (877-727-3669) to charge your order
2. Enclose a check when mailing your order to:
38 Pleasant Bend Dr., The Woodlands, TX 77382
3. Fax this form with credit card number (832-201-9921)
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