Mylan Order Form

Billing Contact

Name and Position:(required)

Billing Address:(required)

Billing Email Address:(required)


Shipping Contact

Shipping Address:(required)

Shipping Contact Name:(required)

Shipping Contact Tel Number:(required)

Date Req:(required)

Ordering Process

1. Make sure all fields are completed

2. Include a PO number if that is to be included on the invoice

3. Be sure to include list of participants below

4. Insights will send invoice to Billing Contact via PDF after the session

Be sure to allow plenty of time for follow up and shipping of materials.

Package #1

Profile only, 3 Chapter (Foundation Management and; Sales): SOFT COPY – $140.00

Profile only, 3 Chapter (Foundation Management & Sales): HARD COPY – $140.00

Package #2

3 Chapter Profile, Learning Guide, Blocks, Team Wheel – $200.75

Package #3

3 Job Aid:

Job Aid:

Insights 9′ Mat

Insights Overlay Mat

Your List of Attendees

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