Please fill out the information below, indicating the number of IMAGE and/or ICCP assessments you wish to order for your online account. When you are finished, click on the View Order button to view your order. Then print out the invoice using the Print option from your browser's 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:

You will receive your account user name and password along with instructions on how to use your account via e-mail or regular post (if no e-mail address is specified) upon receipt of your order.

Item Name	Quantity	Unit Price	Total
IMAGE Assessment		$15.00
ICCP Profile		$15.00
TOTAL AMOUNT DUE

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