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.

Contact Information

First Name:^*

Last Name:^*

E-mail Address^*

Confirm E-mail^*

Password:^*

Confirm Password:^*

Educational Institution

Name^*

Tax Exempt ?

Yes

Tax Exemption #^*

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

Billing Address

First Name:^*

Last Name:^*

Billing Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Shipping Address

Click box if same as Billing Address:

First Name:^*

Last Name:^*

Shipping Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Fax Number

Institution Details

Institution

Pre-School/School

University

Other

Website Address

Authorized Buyer(s)

Authorized Buyer 1 Signature (Print Name)

Authorized Buyer 2 Signature (Print Name)

Education Discount Program Application

Contact Information

Educational Institution

Billing Address

Shipping Address

Institution Details

Authorized Buyer(s)

Verify security code