form - evan-moor.com
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❏ Purchase order enclosed ❏ Purchase Order # ________________
Billing Information
School/District Name _______________________________________________________________________
School/District Address ______________________________________________________________________
School/District City _________________________________________State _____Zip Code ______________
Purchasing Officer Contact Name (first and last) __________________________________________________
Purchasing Officer Phone ______________________________ Fax _________________________________
Purchasing Officer Email ____________________________________________________________________
If more than one school is purchasing interactive courseware and/or student licenses powered by Portals School, please include additional forms for each school.
School Information
School Name _____________________________________________________________________________
School Address ____________________________________________________________________________
School City ________________________________________________State ______ Zip Code ____________
Site License Manager Contact Name (first and last) ________________________________________________
(The Site License Manager will manage setting up teacher and student accounts.)
Site License Manager Phone__________________________ Fax ____________________________________
Site License Manager Email __________________________________________________________________
Will the Site License Manager use interactive courseware and student licenses? ___Yes ___No
Student Licenses ($5.99 each per student per year)
Number of Students _____________________ Student License Activation Date ________________________
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Email:[email protected] Fax:1-800-777-4332
Mail:Evan-Moor Educational PublishersAttn: Portals School Purchase Order18 Lower Ragsdale DriveMonterey, CA 93940-5746
Please complete this form and submit it with your purchase order for interactive courseware and/or student licenses powered by Portals School.
Interactive Courseware ($199.99 each per school account, perpetual license)
A Word A Day Daily Geography Practice
❏ Grade 1 ❏ Grade 1
❏ Grade 2 ❏ Grade 2
❏ Grade 3 ❏ Grade 3
❏ Grade 4 ❏ Grade 4
❏ Grade 5 ❏ Grade 5
❏ Grade 6 ❏ Grade 6
Daily Language Review Daily Reading Comprehension
❏ Grade 1 ❏ Grade 1
❏ Grade 2 ❏ Grade 2
❏ Grade 3 ❏ Grade 3
❏ Grade 4 ❏ Grade 4
❏ Grade 5 ❏ Grade 5
❏ Grade 6 ❏ Grade 6
❏ Grade 7 ❏ Grade 7
❏ Grade 8 ❏ Grade 8
Daily Science Daily Word Problems: Math
❏ Grade 1 ❏ Grade 1
❏ Grade 2 ❏ Grade 2
❏ Grade 3 ❏ Grade 3
❏ Grade 4 ❏ Grade 4
❏ Grade 5 ❏ Grade 5
❏ Grade 6 ❏ Grade 6
Look, Listen, & Speak
❏ At Home
❏ At School
❏ Keeping Healthy
❏ My Community
❏ My Family & Me