Order Mindex Online Profile

Order Introductory Profile (Online)
The Mindex Introductory Profile is intended to enable human development professionals to evaluate the Mindex product and decide whether they want to apply for certification. It is not generally intended for use as a "consumer" product by untrained people. Introductory Profiles are limited to one per customer, unless ordered by a Certified Mindex User. We'll E-mail your UserID and Password within 5 business days.
(*) Company
(*) Address
(*) City & State/Province
(*) Zip/Postal Code
(*) Country
(*) Last Name
(*) First Name
(*) Title/Department
Telephone
Fax
(*) Email
Tell Us About Yourself (One Paragraph)	Please tell us how you first learned about Mindex: Word-of-mouth referral Internet search Prior purchases Prior contact/discussions Advertising Other:
(*) Please check the "Agree" button if you agree to abide by the standards for ethical use of Mindex products: Agree Do Not Agree
Please confirm your selection and credit card payment below:
Product:	Qty:	x Price (ea.):	Total:
		USD $35.00
		Add Calif Tax? (7.75%)
		Add shipping/handling	$10.00
		Grand Total:
Method of Payment:
Visa MasterCard AmEx Check Bank Wire
Name (Exactly as on Card)
Billing Address (Exactly as on Card Account)
Card Number
Authorization Code	(3 or 4 digits, required)
Exp. Date (mm/yy)
Payment required with order. We ship after payments clear our bank. Contact us for check payment or bank-wire procedures. NOTE: we do not store your credit card number on our server.