Products

Respondus Offline Order Form


Purchase Orders

Purchase orders (net 30 days) are accepted from government and accredited educational institutions and major corporations, provided that they are submitted on purchase order forms with a purchase order number. Final payments must be made in US dollars drawn on a US bank. Please be sure to provide the order form below with all orders.

Purchase orders can be sent to:

Mailing Address:
Respondus, Inc.
8201 164th Ave NE, Suite 200
P.O. Box 3247
Redmond, WA 98052
Fax: 425-881-3329
E-mail: sales@respondus.com (send as a PDF)

Checks
Check payments must be in US dollars drawn on a US bank, or you can send international money orders in US dollars. Please be sure to provide the order form below with all orders. Mail to: Respondus, Inc., 8201 164th Ave NE, Suite 200, P.O. Box 3247, Redmond, WA  98052.

Indicate how many copies of Respondus are being purchased:

_____Respondus Single-user license(s) @ $149 each= ________
Washington state residents add sales tax (9%)+ ________
Total Payment________

Payment Information:
Please use large and legible hand-writing

[ ] Check # ___________

[ ] Purchase Order # ______________

[ ] Credit Card:
  [ ] MasterCard  [ ] VISA  [ ] AMEX  [ ] Discover

Please use large and legible hand-writing

Credit Card #: ______________________________________

Expiration Date: _______________

Today's Date: ______________

Name on Card: _____________________________

Cardholder E-mail Address: _____________________________

Signature: _____________________________

Send To Information:

Name:______________________________________
Institution: ______________________________________
Address: ______________________________________

______________________________________

City, State/Prov:______________________________________
Zip/Postal: ______________________________________
Country:______________________________________
Day Phone:______________________________________
E-mail:______________________________________
Fax:______________________________________

How do you want your Respondus Activation Password(s) sent to you? (check one)

[ ] E-mail   [ ] Fax