Person in Charge - sales order form

Person in Charge – sales order form
Please complete in black ink and block capitals.
1 Contact details
4 Credit card payment
All credit cards EXCEPT American Express are accepted
Type of card (e.g. VISA):
Name on card:
Card number:
Name:
Tel no:
Email address:
2 Centre details
Centre name:
Centre number:
Issue:
Invoice address:
Valid from date:
/
Valid to date:
Security code:
/
(The security code is the last three digits of the number shown on
the signature strip).
Registered card address:
2 Delivery details
Delivery address:
5 Payment total
Please indicate your product selection on the list overleaf
and state your total costs here:
Shipment required by:
(Shipment takes at least 3 working days to reach destination)
Total
order value (USD)
Exam date (PIC):
$
Exam venue:
3 Purchase order number
Your ref:
The CIEH is registered under the Data Protection Act. Information will not be
passed to third parties.
Prices_PIC_v1 11–11
Chadwick House Group Ltd (CHGL) is the trading arm of the CIEH, Registered
Company no: 1999717
For internal use only
Sales order number:
Date:
/
/
To complete your order please scan
your completed order form and email
it to us at [email protected]
If you have any questions, please call
us on 04 454 1241
Additional order forms can be
downloaded from www.cieh.org/training
Terms:
Ref: CSMOF_PIC
Person in Charge sales order form
Please indicate your quantities in the table below
PIC fees list
Please complete in black ink and block capitals.
Quantity
Unit price
USD
Level 3 PIC examination paper (inc re-sit)
$25.00
TOTAL
Can be sold as a combination
Level 3 PIC combination deal includes handbook and invigilation
$46.00
Level 2 PIC Paper examination paper (inc re-sit)
$19.00
Can be sold as a combination
Level 2 PIC combination deal includes handbook and invigilation
$40.00
PIC handbook (for level 2 and 3)
$20.00
Can be sold as a combination
PIC Invigilator fee
$70.00
Plus $7 per candidate when there are more than ten people
PIC re-mark
$40.00
PIC replacement certificate
$32.00
Please write your quanities above and fill in total costs in section 5 (overleaf)
NOTES:
Prices are valid from 1 July 2011 – 31 December 2012.
This form should be sent to CIEH at least 28 days prior to the date of examination and any amendments should be
confirmed in writing at least 28 days prior to the exam.
Orders and amendments done within 28 days of the exam will be subject to an additional administration fee
of $150 (USD).
For security reasons all orders must be signed for on delivery.