Brainchild Learning Tools: Mechanics Order Form

Mechanics Quotation Form
Choose Titles and Number of Classrooms
(up to 35 students per classroom)
Fill in number of classrooms next to each title box.

Reading (3 levels)
Writing (3 levels)
Vocabulary (3 levels)

Math Level 1
Math Level 2

Calculate Order
$	License Price
x	# of Classrooms
	Total Amount

General Information
Brainchild will provide a form for teachers to fill in their names and the names of their students. Students may be added or deleted from a classroom. Administrators and teachers receive user names and passwords to view reports.
This is an annual subscription.

Ship to:		Bill to:
School:		Agency:
Contact:		Dept:
Email:		Address:
Address:		City:
City:		State:	Zip:
State:	Zip:	PO#:
Phone:		Local Sales Rep:

To place an order, print this page and fax it to this number: 239-263-3439