Colleges and Universities Purchase Information

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University Name / College Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Contact Person's Name *

Contact Person's Phone *

Contact Person's Email Address *

Select *

Quote for course membership type (Check all that apply) *Per StudentFlat Rate Monthly MembershipFlat Rate Quarterly MembershipFlat Rate 6 Month MembershipFlat Rate Yearly Membership

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