Text Box: Order Form

  Use this form to fax or mail orders. To purchase online, click on Programs/Subscriptions you wish to purchase, and click the BUY button. 

Name:___________________________________________________________________________
Law Firm or Company:______________________________________________________________
Address:________________________________________________________________________
Email Address:____________________________________________________________________
Telephone No.:_______________________________   Fax No.:_____________________________
State Bar # or Registration # (Where Applicable)               Requested Password for Online Access:
  ______________________________________             ___________________________________

Course Name

Course No.

Type
(Audio, Video, Online)

Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subtotal:

$

 

Shipping & Handling:  Regular: DHL Ground 3-5 Business Days Price: $15.00

 

 

Overnight: $25.00 (Per Item)

 

 

Sales Tax: (Florida )

 

 

Total:

 

PAYMENT INFORMATION:
ڤ VISA ®    ڤ MASTER CARD®       ڤ AMERICAN EXPRESS®     ڤ DISCOVER ®    ڤ CHECK ENCLOSED

Credit Card No. ____________________________________ Expiration Date:_____________
Amount: __________________________________  Check No.___________________
Billing Address (if different than above):
___________________________________________________________________________
Phone Number:  _____________________  E-Mail address:___________________________
                                                                       (once charge is processed an e-mail will be sent)
Signature: _______________________________   Print Name:__________________________

www.celesq.com   
 Tel: 561.241.1919   
       Fax: 561.241.1969         

Celesq®, Inc.
6421 Congress Avenue, Suite 100
Boca Raton, FL  33487