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Description	Quantity	Cost per Item	Total
		SubTotal:	$USD 0.00
		Total Shipping:	$USD 0.00
		Total Order:	$USD 0.00

Billing Address
Please fill out the following information with the address that appears on your credit card bill.

* required field

* First Name
* Last Name
Organization
* Billing Street Address
Address (cont.)
* City
* State/Province
* Zip/Postal Code
Country
* Phone
* E-mail

Shipping Address

Click here if billing address is the same as the shipping address

Click here if you'd like us to hand deliver your purchase to a student attending a Teva Learning Center program. This will wave all shipping charges. Please fill out the below information so we can deliver your order:

* Student Name:
* School Name:
* Date:

Click here if the shipping address is different then the billing address

* First Name
* Last Name
Organization
* Street Address
Address (cont.)
* City
* State/Province
* Zip/Postal Code
Country

Credit Card Information:

* Name as it appears on a Credit Card:
* Credit Card Number (Visa or Mastercard):
* Expiration Date:
* Zip Code on Credit Card:
Cost of Order (before Shipping and Handling):	USD 0.00
Cost for Shipping:	USD 0.00
Total Amount of Order (with Shipping):	USD 0.00

Additional Comments:

All the above information is for processing the order only. All information is confidential and will not be sold or used for any purpose besides processing this order.

If there is an issue with the order, a message will be emailed to you so the order can be processed correctly. After it has been processed a receipt will be sent to your billing address.

Please note that there will be a charge on your credit card statement from our parent organization 'Surprise Lake Camp' (which may read as SLC).