| New
Online Customers
(Repeat
& Current Customers: Do Not Use This Page)
This
Online Order Form is designed for new customers paying by credit
card only. To place an order using a credit card that is in the
name of someone other than the subscriber (such as an employer or spouse),
for groups of two or more persons using the same credit card information,
or for other payment methods, please go to our Mail/Fax
order page.
Repeat
customers and current subscribers should Sign
In first, add items to the Shopping Cart, and then Proceed to Checkout.
*
represents that this item needs to be filled out
|
| Mailing
Address |
| Your
subscription materials and other purchases will be sent to this address.
For subscriptions that will be sent to your work address, be sure to enter
the name of your facility and the name of the department where you work,
including room numbers, mail stop numbers, or other directions that will
help your mailroom complete the delivery correctly. |
| *First
Name: |
|
| *Last
Name: |
|
| Degrees/Certifications:
|
|
| Company/Institution
Name: |
|
| Department:
|
|
| *Street
Address 1: |
|
| Street
Address 2: |
|
| *City:
|
|
| *State/Province:
|
|
| *ZIP/Postal
Code: |
|
| *Country:
|
|
| Contact
Information |
| This
information will help us reach you if there is a question about your order.
Your e-mail address will also allow us to provide a variety of important
services to you: e-mail notification when new CME papers in your subscription
are posted online, e-mail renewal notices that include a link to a personalized
form for easier, faster ordering, and reminder notices if you forget the
ID Number and Password required for access to the materials and services
provided to Subscribers Only. |
| *Daytime
Telephone: |
Ext:
|
| Fax:
|
|
| *Your
E-Mail Address: |
|
| Billing
Information
Check to copy mailing address |
| This
information must match the billing address on file with the credit card
company. When you purchase items, this information will be compared against
your credit card number for authentication and security purposes. |
| *First
Name: |
|
| *Last
Name: |
|
| Company/Institution
Name: |
|
| Department:
|
|
| *Street
Address 1: |
|
| Street
Address 2: |
|
| *City:
|
|
| *State/Province:
|
|
| *ZIP/Postal
Code: |
|
| *Country:
|
|
| Credits
Reported Directly to ARDMS or CCI for You |
| Chrestomathic
Press, Inc., can report your CME credits directly to ARDMS or CCI for you. To
receive this service, you must provide your ARDMS or CCI registry number. You
may decline this service by not entering a registry number. You may request
this service at any time in the future by entering your registry number
on your Personal Subscriber Record. |
| ARDMS
Registry Number: |
|
| CCI
Registry Number: |
|
| Other
Information |
| Physician:
|
|
| Sonographer
or other: |
|
| - |
| Current
Customer: |
|
| Former
Customer: |
|
| New
Customer: |
|
| - |
| Where
did you hear of us? |
|
If all the information about you on this page is correct, please choose
the "Next" button.
|
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