Order Form for Jacobs Inventory of Functional Skills (JIFS)
(Copy this order form for future use)

BILL TO:

SHIP TO: (if different than billing address)

Facility/Practice __________________________________
Your Name ______________________________________
Address ________________________________________
City ____________________ State ____ ZIP ___________
Phone (______) __________________________________
FAX (optional) (______) ___________________________
E-mail (optional) __________________________________

Facility/Practice __________________________________
Your Name ______________________________________
Address ________________________________________
City ____________________ State ____ ZIP ___________
Phone (______) __________________________________
FAX (optional) (______) ___________________________
E-mail (optional) __________________________________

Quantity: (prices are in US dollars)

Unit Price

 

Amount

_____CompuJIFS.................................................................................................................

$269


$________

______ OTR Edition with manual, combined scoring (15), Foundation scoring (20) and Screening forms (20)

$59.00

 

$________

______ OTR Edition, manual only............................................................................................................

$30.00

 

$________

______ OTR combined Life Skills and Foundation Skills scoring forms, 16 pages each (15)................

$21.00

 

$________

______ OTR Foundation Skills scoring forms, 8 pages each (20)............................................................

$16.00

 

$________

______ OTR Screening forms (20) ...........................................................................................................

$ 5.00

 

$________

______ Life Skills Edition with manual, Life Skills scoring forms (15) ................................................................

$35.00

 

$________

______ Life Skills Edition, manual only ....................................................................................................

$25.00

 

$________

______ Life Skills scoring forms, 12 pages each (15)...............................................................................

$17.50

 

$________

 


 Subtotal

 

$________

METHOD OF PAYMENT:


 WI residents add 5.5% sales tax

 

$________

___ Check (Payable to: Strategies for Better Functioning, LLC)


 shipping*

 

$________

___ Purchase Order: # ___________________________


 TOTAL:

 

$________

Sorry, I no longer accept credit card payments.

* for all orders add 10% for shipping.
Please allow one week for delivery.
Contact me via email for overseas shipping and express service charges.
(shipping charges are subject to change)


Submit your order:


Fill out the order form above and mail check or PO payment to:



Strategies for Better Functioning, LLC
P.O. Box 242
Belleville, WI 53508


Your occupation and business are important. If you have any questions, comments or concerns about the JIFS or Strategies for Better FunctioningTM, LLC, please send email to bkjacobs@betterfunctioning.com, or call (608) 455-1644 during business hours CT.

Please explore the web site at betterfunctioning.com for more information and help.