The Organizational Clinic Support
Email: customerservice@organizationalclinic.com

Order Form - Academic Use

Printable Version

Service Order Form

Organizational Information
Address
Organizational Products
Organizational Service(s)
Primary Contact
Profile of Department to be Assessed
Contractor Arrangement
Performance Improvement Consultant is assigned by The Organizational Clinic
The contractor is the professional that will be conducting the consultation exercise
Code & Fee
Payment Plan
No subsequent payments
No Finance Fees Added
Pay on Day 30
2.5 % Finance Fee Added
50% on day 30; 50% on day 60
5% Finance Fee Added
Method
Credit / Debit Cards
Authorization
Signature of Authorized Representative
Sign above
Primary Contractor
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