Listed below are the services available from our Web site. Please enter the number of items desired for each service. The totals will be filled in automatically. Do not forget to indicate if you are an Indiana resident to calculate the appropriate sales tax. When you are finished, click on the View Order button to view your invoice. Then print out the invoice using the Print option from your browser's File menu or by clicking the printer icon in your browser's toolbar. Make checks payable to "Life Discovery Interactive" and mail them along with the printed order form to:

Available to Individuals	Quantity	Unit Price	Total
IMAGE Self-Scoring Inventory		$20.00
(Shipping)			$5.00
(If you are an Indiana resident, check this box to add sales tax.)
TOTAL AMOUNT DUE

Available to Qualified IMAGE Administrators	Quantity	Unit Price	Total
Standard IMAGE Questionnaire		$5.00
IMAGE Self-Scoring Inventory		$20.00
IMAGE Suite Software		$50.00
(Shipping)			$5.00
(If you are an Indiana resident, check this box to add sales tax.)
TOTAL AMOUNT DUE

Name:
Organization*:
Title*:
ID#*:
Address:
City/State/Zip
Home phone:
Work phone:
E-mail:

* Fill this out only if you are a qualified IMAGE Administrator.