NORTH EAST ASSESSMENT TOOLS
NEAT, LLC
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                                                ORDER FORM
Payable to:

North East Assessment Tools, LLC
43 Elmwood Street
Portland, Maine (USA) 04103

(207) 272-4646 or (207) 799-1482
info@www.neattests.com

                  We accept check, money order, purchase order, or Paypal
                                                      (follow "add to cart" link on home page)  



ManageMed Screening ©  cost $60.00
(plus $10 shipping and handling per kit for orders shipped in the United States)
*Canadian Customers please include additional $20 check cashing fee and $20 for shipping and handling)   
Maine residents please add 5.5% sales tax.   
Total number of ManageMed kits ______  Price________________

SAFE AT HOME Screening ©** (manual and test items)  cost $35.00
(plus $5 shipping and handling per kit for orders shipped in the United States)
*Canadian Customers please include additional $10 check cashing fee and $15 for shipping and handling)
Total number of SAFE AT HOME (Screen) kits_____ Price _________________
Maine residents please add 5% sales tax.



                                                                   Total enclosed__$_____________

                       ** Each SAFE AT HOME Screening © order must be
                                    accompanied by a signed disclaimer**.


Ship to: _____________________________________________________________

Address:_____________________________________________________________ ____________________________________________________________________
____________________________________________________________________

Telephone Number and/or email: _________________________________________
 
                                      THANK YOU FOR YOUR ORDER!

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