TSCPA/Surgent's Essential CPE Collection
Mail and Fax Order Form

Name: ________________________________________________________________________

Firm: _________________________________________________________________________

Address: ______________________________________________________________________

City: _____________________________ State & Zip Code: ______________________________

Business phone:________________________________________________________________

Home phone:___________________________________________________________________

E-mail: ________________________________________________________________________

Cost: 199.95 + tax _____________ + $9.75 S/H  =_____________

Check American Express, Visa, MasterCard

Card Expiration Date: _______/_______

Card Number: ________________________________________________________________

Cardholder's Name: ___________________________________________________________

Cardholder's Signature: ________________________________________________________

Call the CPE InfoLine at 800.428.0272 (972.687.8500 in Dallas) for more information.