Order Form

	Condensed	Standard	Deluxe	Standard/Deluxe	Boxes	Refills	Total
	Course¹	Course²	Course³	Refill	Desired	Desired	Cost
	(Flat Rate)	(9 months)	(9 months)
Topics I	NA	NA	$50.00	N/A / $12.50
Topics II	NA	NA	$50.00	N/A / $12.50
General Science I	$225.00	$50.00	$85.00	$15.00 / $25.00
General Science II	$225.00	$50.00	$85.00	$15.00 / $25.00
General Science III	$225.00	$50.00	$85.00	$15.00 / $25.00
Life Science	$225.00	$50.00	$85.00	$15.00 / $25.00
Earth Science	$225.00	$50.00	$85.00	$15.00 / $25.00
Physical Science	$225.00	$50.00	$85.00	$15.00 / $25.00
Biology	$250.00	$55.00	$95.00	$20.00 / $30.00
Chemistry	$275.00	$60.00	$110.00	$25.00 / $35.00

(Please circle your chosen course or courses.)

¹The condensed course is 6 labs and 1 payment. Texas residents include sales tax of 8.25% _________

²The standard course is 14 labs and 9 monthly payments. Registration fee $25, (waived for previous customers) _________

³The deluxe course is 30 labs and 9 monthly payment. Deposit of $75 per subject _________

The deluxe course for Topics is 16 labs. Total amount enclosed _________

Methods of Payment:

1. Your credit card will be billed monthly. (The deposit fee will be billed upon enrollment.)

2. Please call for other payment options.

Science Labs-in-a-Box, Inc. Phone 800-453-1708

PO Box 1657 Fax 512-268-2766

Kyle, TX 78640

Rental Agreement: I accept full responsibility for the care of the equipment while it is in my possession. I agree to return all rental equipment by the agreed date in clean condition to avoid any additional charges. I further agree that if the equipment is not returned, I will be responsible for the replacement at full retail value of any equipment rented. I further understand that if the boxes are not returned on schedule that there is a $10.00 per week late fee for each additional week.

Hold Harmless Agreement: As is the case in any science lab setting, I understand there are inherent and other risks and I agree to follow all safety rules and use safety equipment. This program is designed to be used by an adult in the instruction of children and not intended to be used by unsupervised children. I hereby release Science Labs-in-a-Box, Inc. and including but not limited to its owners, agents and employees for any loss or damage, including any that results from claims for personal injury or property damage related to the use of this equipment.

I, the undersigned, have read and understood the agreements above.

Signature _______________________________ _______________________

(Required) (Date)

Name: ________________________	Please check one to indicate how you wish to pay.
Address: ___________________________ __________________________________ (UPS requires street or box with rural route number)	[ ] Other [ ] MC [ ] Visa
City: _________________________ State & zip: ____________________	Card #: _____________________________ Expiration Date: ________
Tel # (_____) __________________	Signature: ____________________________
Fax # ( ____) __________________	E-mail address: ________________________

[ ] September 1st [ ] September 15th [ ] October 1st [ ] Other: _______________
Please select when you would like to start your first box: (Orders received less than 30 days before the start date may be delayed.)

Copyright © 2005 Science Labs-in-a-Box