2016–2017 Order Form for the ACT ® Test
Multiple-Choice and Writing Sample Test Booklets
ACT makes ­available for sale the ­following released test forms. Administration instructions for a simulated test session are ­included
with each order. Practice multiple-choice tests (Form 1572CPRE) and a practice writing test (Form 15AA51) appear in the free
student test ­preparation booklet, Preparing for the ACT®Test, available for download as a PDF at www.actstudent.org. All booklets
are copyrighted and may not be reproduced or altered.
Item
Item Number
Quantity
Unit Price
Total Cost
For Purchase by Test Prep Organizations ONLY—Includes scoring instructions and a sample answer document within the test booklet.
ACT Sample Test Booklet—1460E (pkg of 25)
ACT Sample Test Booklet—1163E (pkg of 25)
08030115PT
08011412PT
________ x $71.00/pkg= ___________
________ x $71.00/pkg= ___________
For Purchase by High Schools and Colleges ONLY—Includes scoring instructions and a sample answer document within the test booklet.
ACT Sample Test Booklet—1467F (pkg of 25)
ACT Sample Test Booklet—1165D (pkg of 25)
08030015PT
08011712PT
________ x $36.00/pkg= ___________
________ x $36.00/pkg= ___________
For Purchase by Either Group (administered AFTER the multiple-choice tests)
ACT Sample Writing Test Booklet—15AC15 (pkg of 25) 08011517W
_______ x $13.00/pkg= ___________
TOTAL amount=
___________
TOTAL payment for quantity ordered (see box below)=
___________
High School or College Signature Required—By signing below, I represent to ACT that these booklets are being purchased by a
high school or college, solely for use by that high school or college for delivery to its students.
Signature:_________________________________________________________________________ Date:__________________________
Sales Tax and Payment Information
Customers will be charged applicable state and local sales taxes in states where required. A list of required states can be found at
www.act.org/orderinfo. If sales tax is required, please c­ alculate the appropriate sales tax based on your shipping address and add to
the order total.
If you are exempt from sales tax, please refer to the instructions found at www.act.org/orderinfo. The appropriate ­documentation must be
received by ACT before tax-exempt status will be granted.
Orders totaling $20.00 or less must be accompanied by check or money order payable to ACT. All other orders will be invoiced by ACT. ­Acceptable
forms of payment include: check, credit card (MasterCard, Visa, Discover, American Express), wire, or Automated Clearing House (ACH).
If you have any tax or payment questions, please contact the Accounting Department at 319.337.1150.
SHIP TO: (Please print or type)
BILL TO: (If different than Ship To)
_____________________________________________________
Name/Title
_____________________________________________________
Purchase Order Number (if required by your institution)
_____________________________________________________
Institution/Organization Name
_____________________________________________________
Name/Title
_____________________________________________________
Street Address (Do not use PO Box number)
_____________________________________________________
Institution/Organization Name
_____________________________________________________
City, State/Province, ZIP/Postal Code
_____________________________________________________
Mailing Address
_____________________________________________________
(Area Code) Phone Number
(Area Code) Fax Number
_____________________________________________________
City, State/Province, ZIP/Postal Code
_____________________________________________________
Recipient’s Email Address (Print in all capital letters)
_____________________________________________________
(Area Code) Phone Number
(Area Code) Fax Number
Telephone Number: 319.337.1429
© 2016 by ACT, Inc. All rights reserved.
Email: customerservices@act.org
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