Discovery Education - Request to Purchase/title> <link href="/css/aboutUs.css" rel="stylesheet" type="text/css"> <link type="text/css" rel="stylesheet" href="http://www.discoveryeducation.com/css/de_header/de_header_css_pre.cfm?style=PRE&headerWidth=990&hubURL=http://www.discoveryeducation.com&"> </head> <body> <div id="globalBase" align="center"> <div id="globalGutter" align="center"> <div id="globalStage" align="left"> <div id="shell"> <div id="preNav" align="center"> <div id="preNavButtons" align="center"> <ul class="preNavList"> <li class="btnPRODUCTS"><a href="http://www.discoveryeducation.com/products/" title="Products & Services" >Products & Services</a></li> <li class="btnCLASSROOM"><a href="http://school.discoveryeducation.com" title="Classroom Resources" >Classroom Resources</a></li> <li class="btnHOME"><a href="http://school.discoveryeducation.com/homeworkhelp/homework_help_home.html" title="Home Resources" >Home Resources</a></li> <li class="btnDEN"><a href="http://www.discoveryeducation.com/professional-development/" title="Professional Development" >Professional Development</a></li> <li class="btnSTORE"><a href="http://teacherstore.discovery.com" target="_blank" title="Store" >Store</a></li> </ul> </div> </div> <div id="loginLinks" align="right"> <a href="http://www.discoveryeducation.com/user_login.cfm?type=el">Educator Login</a> | <a href="http://www.discoveryeducation.com/user_login.cfm?type=pl">Passcode Login</a> </div> <div id="shellBottomBar" align="center"> <div id="shellBottomBarLeft"></div> <div id="shellBottomBarRight"></div> </div> <a id="productLogo" href="http://www.discoveryeducation.com" title="Discovery Education"> <img src="http://www.discoveryeducation.com/images/de_header/PRE/logo.jpg" height="53" width="89" border="0"/> </a> </div> <div id="preContent"> <style type="text/css"> #purchase {background: transparent url(../images/spacer.gif) repeat-y;} </style>  <div id="prodBase" class="overview" style="width:990px;margin-left:-8px;padding:0px;"> <div class="xBody" style="width:990px;"> <h1><span>Request to Purchase</span></h1> <div class="p" align="center"> <div id="purchase" align="left"> <div class="content" align="left"> Complete this form as the first step in providing extraordinary Discovery Education resources for your classrooms. <form action="" name="purchaseRequest" id="purchaseRequest" method="post"> <input name="strSchlPID" id="strSchlPID" type="hidden" /> <h3>1. School and Contact Information (required)</h3> <div id="findLink" style="display:none;"> <span class="micText"><b><a href="javascript:popUp('/purchase/MDR_lookup.cfm')" class="micLink" >Find Your School</a></b></span></div> <br /><br /> <div id="findSchool" align="left" style="height:70px; padding-left:20px; padding-top:0px; display:;"> <div align="left" id="purchase_find"> <a href ="##" onclick="javascript:popUp('/purchase/MDR_lookup.cfm')"><img src="/images/spacer.gif" border="0" height="35" width="197"/></a> </div> </div> <div id="hideForm" style="display:none;"> <table border="0" cellpadding="0" cellspacing="0"> <tr> <td valign="top"> <table border="0" cellpadding="0" cellspacing="0"> <tr> <td class="left-layout"> School Name: </td> <td class="right-layout"> <input class="required" title="School Name is Required" name="strSchlName" id="strSchlName" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> School Address: </td> <td class="right-layout"> <input class="required" title="School Address is Required" name="strSchlAddress" id="strSchlAddress" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> School City: </td> <td class="right-layout"> <input class="required" title="School City is Required" name="strSchlCity" id="strSchlCity" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> School State: </td> <td class="right-layout"> <select class="required" title="School State is Required" name="selSchlState" id="selSchlState"> <option value="">--Select State--</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> Zip: <input class="required validate-zip" title="A 5 Digit Zip is Required" name="strSchlZip" id="strSchlZip" size="5" style="width:40px;" type="text"/> </td> </tr> <tr> <td class="left-layout"> Grade Level: </td> <td class="right-layout"> <input class="required" title="Grade Range or Level is required" name="strGradeLevel" id="strGradeLevel" size="8" style="width:50px;" type="text"/> Enrollment: <input class="required validate-digits" title="Please Estimate Enrollment" name="strEnrollment" id="strEnrollment" size="15" style="width:65px;" type="text" value=""/> </td> </tr> </table> </td> <td style="padding-left:60px;" valign="top"> <table border="0" cellpadding="0" cellspacing="0"> <tr> <td class="left-layout"> Bill to Contact: </td> <td class="right-layout"> <input class="required" title="A contact Name is Required" name="strContactName" id ="strContactName" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> Bill to Phone: </td> <td class="right-layout"> <input class="required validate-phone-us" title="A Phone Number is Required </br> xxx-xxx-xxxx" name="strBillToPhone" id="strBillToPhone" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> Bill to eMail: </td> <td class="right-layout"> <input class="required validate-email" title="A Valid eMail is Required" name="strBillToEmail" id="strBillToEmail" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> Confirm eMail: </td> <td class="right-layout"> <input class="required validate-email-confirm" title="Your eMail does not match" id="strConfirmEmail" type="text" size="30" style="width:166px;" /> </td> </tr> <tr> <td class="left-layout"> Contact Method: </td> <td class="right-layout"> <div id="validate-group"> <input name="rdoPreferredContactMethod" id="rdoPreferredContactMethod" type="radio" value="email" /> eMail <input class="validate-one-required" title="Select a Preferred Contact" name="rdoPreferredContactMethod" id="rdoPreferredContactMethod" type="radio" value="phone" /> Phone </div> </td> </tr> </table> </td> </tr> </table> </div> <div id="product-tables"> <h2>2. Select Products and Services (required)</h2> <div id="advice-validate-one-required-chkDEMS" class="custom-advice" style="display:none">Please Select One of the Products Below</div> <table border="0" style="border:#666666 solid 1px;" cellspacing="0" cellpadding="0"> <tr> <td width="40" class="headsB" align="center"> Check </td> <td width="315" class="heads"> Products and Services<br /> </td> <td width="130" class="heads"> Grades K-8<br /> (per building per year)<br /> </td> <td width="130" class="headsL"> Grades 9-12<br /> (per building per year)<br /> </td> </tr> <tr> <td class="blueheads"> </td> <td class="blueheads"> Digital Subscription Services </td> <td class="blueheads"> </td> <td class="blueheads"> </td> </tr> <tr> <th class="check-col2" rowspan="7"> <div id="validate-group2"> <input name="chkDEUS" id="chkDEUS" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="yes" /> <br /> <input name="chkDEUSplus" id="chkDEUSplus" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="yes" /> <br /> <input name="chkDESms" id="chkDESms" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="yes" /> <br /> <input name="chkDESes" id="chkDESes" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="0" /> <br /> <input name="chkDES" id="chkDES" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="0" /> <br /> <input name="chkDEH" id="chkDEH" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="0" /> <br /> <input class="validate-one-required" name="chkDEMS" id="chkDEMS" type="checkbox" style="margin-top:21px;margin-bottom:21px;" value="yes" /> </div> </td> <td class="prod-col"> <a href="/products/streaming/streaming.cfm" target="_blank"> <img src="/images/purchase/streamingLogo.jpg" alt="" border="0"/> <br /> Discovery Education streaming* 4,000 videos</a> </td> <td class="price-col"> $1,570 </td> <td class="price-col"> $2,095 </th> </tr> <tr> <td class="prod-col"> <a href="/products/streaming/" target="_blank"> <img src="/images/purchase/streamingLogo.jpg" alt="" border="0"/> <br /> Discovery Education streaming Plus* 7,700 videos</a> </td> <td class="price-col"> $2,615 </td> <td class="price-col"> $3,095 </td> </tr> <tr> <td class="prod-col"> <a href="/products/science/middle.cfm" target="_blank"> <img src="/images/purchase/scienceLogo.jpg" alt="" border="0"/> <br /> Discovery Education Science for Middle School*</a> </td> <td class="price-col"> $1,995 </td> <td class="price-col"> N/A </td> </tr> <tr> <td class="prod-col"> <a href="/products/science/elementary.cfm" target="_blank"> <img src="/images/purchase/scienceLogo.jpg" alt="" border="0"/> <br /> Discovery Education Science for Elementary*</a> </td> <td class="price-col"> $1,695 </td> <td class="price-col"> N/A </td> </tr> <tr> <td class="prod-col" style="padding-top:7px;"> <a href="/products/science/" target="_blank"> <img src="/images/purchase/scienceLogo.jpg" alt="" border="0"/> Discovery Education Science K-8 (both Middle School and Elementary)</a> </td> <td class="price-col"> $1,995 </td> <td class="price-col"> N/A </td> </tr> <tr> <td class="prod-col"> <a href="/products/health/" target="_blank"> <img src="/images/purchase/healthLogo.jpg" alt="" border="0"/> <br /> Discovery Education Health*</a> </td> <td class="price-col"> $1,695 </td> <td class="price-col"> $1,695 </td> </tr> <tr> <td class="prod-col"> <a href="/products/mediaShare/" target="_blank"> <img src="/images/purchase/demsLogo.jpg" alt="" border="0"/> <br /> Discovery Education MediaShare </a> </td> <td class="price-col"> $495 </td> <td class="price-col"> $495 </td> </tr> </table> <span class="subs">*special pricing available for buildings with low student enrollment (less than 200 students)</span> <br /> <br /> <table border="0" style="border:#666666 solid 1px;" cellspacing="0" cellpadding="0"> <tr> <td width="40" class="blueheads"> </td> <td width="315" class="blueheads"> Hardware Solutions </td> <td width="130" class="blueheads"> </td> </tr> <tr> <td class="check-col2"> <input name="chkDMS2" id="chkDMS2" type="checkbox" value="yes" /> </td> <td class="prod-col"> <a href="/products/localHost/" target="_blank"> Discovery Media Server 2TB </a> </td> <td class="price-col"> $6,495 </td> </tr> <tr> <td class="check-col2"> <input name="chkDMS4" id="chkDMS4" type="checkbox" value="yes" /> </td> <td class="prod-col"> <a href="/products/localHost/" target="_blank"> Discovery Media Server 4TB </a> </td> <td class="price-col"> $9,995 </td> </tr> <tr> <td class="check-col2"> <input name="chkDMS9" id="chkDMS9" type="checkbox" value="yes" /> </td> <td class="prod-col"> <a href="/products/localHost/" target="_blank"> Discovery Media Server 9TB </a> </td> <td class="price-col"> $12,995 </td> </tr> </table> </div> <h2>3. Optional</h2> PO Number:<br /> <input name="strPO" id="strPO" type="text" size="30" /> <br /> <br /> Do you currently subscribe to a Discovery Education Service? <br /> <input name="rdoCurrentSubscriber" id="rdoCurrentSubscriber" type="radio" value="yes" /> Yes <input name="rdoCurrentSubscriber" id="rdoCurrentSubscriber" type="radio" value="no" /> No <br /> <br /> If so, what is your current Discovery Education username?<br /> <input name="strUserName" id="strUserName" type="text" size="30" /> <br /> <br /> Have you used a Discovery Education passcode? <br /> <input type="radio" name="rdoPasscode" name="rdoPasscode" value="yes" /> Yes <input name="rdoPasscode" id="rdoPasscode" type="radio" value="no" /> No <br /> <br /> If so, what is it? <br /> <input name="strPasscode" id="strPasscode" type="text" size="30" /> <br /> <br /> Would you like to receive information from Discovery Education via e-mail? <br /> <input name="rdoEmail" id="rdoEmail" type="radio" value="yes" /> Yes <input name="rdoEmail" id="rdoEmail" type="radio" value="no" /> No <br /> <br /> Would you like to learn more about Discovery Education Assessment services?<br /> <input name="rdoAssessment" id="rdoAssessment" type="radio" value="yes" /> Yes <input name="rdoAssessment" id="rdoAssessment" type="radio" value="no" /> No <br /> <br /> Comments or Special Instructions:<br /> <textarea name="txtComments" id ="txtComments" cols="26" rows="4"></textarea> <br /> <br /> <br /> <div align="left" id="purchase_submit"> <a href ="##" onclick="submitform();"><img src="/images/spacer.gif" border="0" height="31" width="136"/></a> </div> </form> <script type="text/javascript"> new Validation('purchaseRequest',{useTitles : true, immediate : true, onFormValidate : formCallback, onSubmit:false}); Validation.addAllThese([ ['validate-password', 'Your password must be more than 6 characters and not be \'password\' or the same as your name', { minLength : 7, notOneOf : ['password','PASSWORD','1234567','0123456'], notEqualToField : 'field1' }], ['validate-email-confirm', 'Your confirmation password does not match your first password, please try again.', { equalToField : 'strBillToEmail' }] ]); </script> </div> </div> </div> </div> <div class="clear"></div> </div> </div> <div style="clear:both;"></div> <div id="footerWrap" align="center"> <div id="globalFooter" align="center"> <a href="javascript:popupWindow('http://streaming.discoveryeducation.com/publicPages/checkRequirements.cfm',545,430);void(0);">Check Requirements</a> | <a href="http://www.discoveryeducation.com/aboutus.cfm?pageid=termsofuse">Terms of Use</a> | <a href="http://www.discoveryeducation.com/aboutus/privacypolicy.cfm">Privacy Policy</a> | <a href="http://www.discoveryeducation.com/aboutUs/contactus.cfm">Contact Us</a> | <a href="http://www.discoveryeducation.com/aboutus/">About Us</a> <br> Copyright © 2008 Discovery Education. 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