Education Discount Program Application

Geographics Customers, please login before completing this form.
The fields will be populated with the existing data from your account.

Fill out the below application and click Submit.
You will receive an automatic confirmation e-mail.
Your application will be checked and an e-mail response will be sent to you within 24 business hours. If you are in a rush, please call us.
Once your application is approved, you can login with the same email and password to take advantage of the EDU discounts of up to 25%.

For questions or assistance, please call 203-644-1271; (800)-436-4919 or email to edu@geographics.com.

First Name:^*

Last Name:^*

E-mail Address^*

Confirm E-mail^*

Password:^*

Confirm Password:^*

Name^*

Tax Exempt ?

Yes

Tax Exemption #^*

Upload Tax Exemption file (pdf, png, jpg, gif)

First Name:^*

Last Name:^*

Billing Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Click box if same as Billing Address:

First Name:^*

Last Name:^*

Shipping Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Fax Number

Institution

Pre-School/School

University

Other

Website Address

Authorized Buyer 1 Signature (Print Name)

Authorized Buyer 2 Signature (Print Name)

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