Survival Statistics Order Form

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Use this form to fax or call in your order

Amount that will be billed to your credit card: $29.95

Visa - MasterCard - Discover - American Express

Name on Card _____________________________________________________________

Card Number ___________________________________________ Exp. Date _________

Signature _________________________________________________________________

We will notify you within 24 hours how to download your copy of Survival Statistics. How would you like to receive these instructions? (select one)

___ Phone: _____________________________________________

___ Fax: _______________________________________________

___ Email: ______________________________________________

Call us: 1-715-442-2261

Order by phone : (715) 442-2261

Order by fax : (715) 442-2262

Click here if you would prefer to order a hardcopy

StatPac Inc.
8609 Lyndale Ave. S. - 209A
Bloomington, MN 55420

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