HydroKit Order Form                       --- Print this form ---
(non-member)
Please circle the "X" mark next to the CD/DVDs you wish to order.
CD/DVD
 Cost Shipping Total
Circle the "X"
Eng Kit $45 $5 $50 X
AGNPS- Kit
 $45 $5 $50 X
Modflow 2005  $45 $5 $50 X
HEC-Kit 
 $45 $5 $50
X
USGS-Kit 
 $45 $5 $50
X
GW-Kit 
 $45 $5 $50
X
EPA-Kit
 $45 $5 $50
X
Save money if you order more than one CD/DVD!
If you are ordering more that one CD/DVD, circle the "X" mark next to the number of CD/DVDs.
Number of CD/DVDs Cost  Shipping   Total Circle the "X"
2 $75 $5 $80 X
3 $110 $5 $115 X
4 $145 $5 $150 X
5 $180 $10 $190 X
6 $215 $10 $225 X
7 $245 $10 $255 X

First Name ________________________________________________________

Last Name _________________________________________________________

Address      _________________________________________________________

                  __________________________________________________________

City           __________________________________________________________

State         ____________________________ Post (ZIP) Code_________________

Country    ___________________________________________________________

Email    ___________________________________________________________

Mastercard  ________  Visa  _________  

Card Number_________________________________Expiration Date____________

Name as it appears on card_______________________________________________

Signature_____________________________________________________________

Mail this form to: IAEH, 2607 Hopeton Dr, San Antonio, TX 78230, USA

Or fax to (USA) 703-564-8581

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