DPS/DISC Ordering Form

Please forward all orders for DPS/DISC materials to:

Marian Mainland
MAINLAND CONSULTING INC.
4 Danube Dr., Heidelberg, Ontario, N0B 1Y0 CANADA
Phone: (519) 699-5429 Fax: (519) 699-4890

NAME:           _________________________________________



AGENCY:         _________________________________________



EMAIL ADDRESS:  _________________________________________



ADDRESS:        _________________________________________



                _________________________________________



                _________________________________________



POSTAL CODE:    ____________________________



PHONE:          (______)  __________________





ITEM #           ITEMS REQUIRED                    PRICE



________ _________________________     _________________



________ _________________________     _________________



________ _________________________     _________________



________ _________________________     _________________



________ _________________________     _________________



________ _________________________     _________________



                         SUBTOTAL:     _________________



                       ADD 13% HST:     _________________



                 SHIPPING CHARGES:     _________________



                            TOTAL:     _________________

                     (In Canadian Dollars)

Prices do not include delivery. Shipping charges for materials will be added to the invoice.

Please make cheque payable to: Mainland Consulting Inc.

Please call Marian directly regarding an individualized DISC workshop

for your agency or for information re: DISC Certification.

Workshops: 

                                       _________________     

August 2010