New Contract Order Form

This form may be used to order etesting.center contract uses online. The form is submitted to the etesting.center administrator for review. When approved, the requested uses will be set up in an account that may be accessed exclusively by agency employees with their clients, patients or students.

The form can be used to order using either a credit card or purchase order for payment. The name of the person who will serve as the contact for the etesting contract as well as that person's details should be completed on the form.

"Number of contract employees" refers to the number of registration numbers needed by the agency for its employees under the contract. Each registration number allows a user to set up a unique username and password on the system to access the etesting uses. Current etesting users may also be added to an etesting contract. Directions for registration are supplied by the admin when the account is set up.

To order test uses, tick the box in the select column next to the tests needed and enter the number of tests needed.

To access ordering by Purchase Order, select "PO" from the drop down menu and complete the information needed to bill for the purchase order (e.g., accounts payable). Purchase orders must also be faxed to B-DI (602-494-2688) before an account can be activated. If total authorized amount exceeds the amount ordered, additional tests may be added by contacting the etesting administrator.

Questions about ordering procedures can be directed to admin@etesting.center



Please Enter Your Contact Details:

First Name *:
Last Name *:
Agency Name *:
Contact Address:
 
City:
State:
Zip:
Contact Email: *
Contact Phone:
Number of
Contract Employees: *

Select The Tests You Would Like to Order:
(minimum of 3 tests each)

Select Test Name Number Amount
Adolescent/Adult Sensory Profile $6.00
Adolescent/Adult Sensory Profile $2.00
ATQ2 $6.00
ATQ2 $2.00
BASICS $5.00
BASICS $2.00
Beck Anxiety Inventory $2.00
Beck Anxiety Inventory $6.00
Beck Depression Inventory-II $2.00
Beck Depression Inventory-II $6.00
Beck Youth Inventory-Anger $5.00
Beck Youth Inventory-Anger $2.00
Beck Youth Inventory-Anxiety $2.00
Beck Youth Inventory-Anxiety $5.00
Beck Youth Inventory-Depression $2.00
Beck Youth Inventory-Depression $5.00
Beck Youth Inventory-Disruptive Behavior $5.00
Beck Youth Inventory-Disruptive Behavior $2.00
Beck Youth Inventory-Self Concept $2.00
Beck Youth Inventory-Self Concept $5.00
Brown ADD Parent 3-7 $5.00
Brown ADD Parent 3-7 $2.00
Brown ADD Parent 8-12 $5.00
Brown ADD Parent 8-12 $2.00
Brown ADD Self 8-12 $2.00
Brown ADD Self 8-12 $5.00
Brown ADD Teacher 3-7 $5.00
Brown ADD Teacher 3-7 $2.00
Brown ADD Teacher 8-12 $2.00
Brown ADD Teacher 8-12 $5.00
Carey Temperament BSQ $2.00
Carey Temperament BSQ $5.00
Carey Temperament BSQ (2013) $2.00
Carey Temperament BSQ (2013) $5.00
Carey Temperament BSQ (IRW4) $2.00
Carey Temperament EITQ $2.00
Carey Temperament EITQ $5.00
Carey Temperament EITQ $2.00
Carey Temperament EITQ $5.00
Carey Temperament EITQ (2013) $5.00
Carey Temperament EITQ (2013) $2.00
Carey Temperament EITQ (IRW4) $2.00
Carey Temperament MCTQ $5.00
Carey Temperament MCTQ $2.00
Carey Temperament MCTQ (IRW4) $2.00
Carey Temperament RITQ $5.00
Carey Temperament RITQ $2.00
Carey Temperament RITQ (IRW4) $2.00
Carey Temperament TTS (IRW4) $2.00
Carey Temperament TTS 1 $5.00
Carey Temperament TTS 1 $2.00
Carey Temperament TTS 2 $5.00
Carey Temperament TTS 2 $2.00
Caterino Adult ADHD Scale $6.00
Caterino Adult ADHD Scale $2.00
Parenting Satisfaction Scale $6.00
Parenting Satisfaction Scale $2.00
TACTIC $5.00
TACTIC $2.00
Your Payment Details:
Payment Method:


PO Info
(only needed if Payment Method is PO)
PO #:
Total Authorized Amount: * $
 
Billing Address:
 
City:
State:
Zip:
Contact Email: *
Billing Contact Phone: