PSI  Fax Order Form

Order Instructions                    Secure Shopping Cart 

1. Your full and complete name exactly as it appears on your credit card, including any middle initials:
If you decide to use another payment method, such as wire transfer (this is the required and only accepted method for some countries), prepaid check , after fill in your name, skip to #6 below and put your payment method in #10.


2. Your billing address on file with the credit card issuer.  This is the address where you receive your monthly credit card statements.



3. Your daytime telephone number with area code _________________________, fax number with area code _________________________& e-mail address: _______________________________

4. Your ___ VISA or ___ MasterCard or ___Amex number or ___Discover Card #: ___________________________________; 

Credit Card's 3 or 4-Digit Verification Code: ___________;  Expiration date:____________.  

Is this a ___ corporate, ___ government or ___ personal credit card?

5. The name of the bank/institution that issued your credit card :____________________________________________

6. The telephone number at the back of the credit card. If your card was not issued in the United States, you must provide us with a local telephone number for the bank or institution that issued your credit card : __________________________________

7. Full description of the item(s) you are ordering, the quantity you need, plus the unit price listed on our web pages or the price quoted to you by email, fax or phone. Don't forget the shipping + insurance costs and perhaps the 3% surcharge (minimum $5.00) for international credit card.




8. The shipping/receiving address if different from credit card's billing address: (Please be advised that we may in cases refuse to ship to a different address.)


9. Please specify the method of shipment : 
For U.S. address: UPS/FedEx  a. ___ Next Day, b. ___ 2 Day, c. ___ 3 Day or d. ___ Ground or Other:_____________

For International Delivery: UPS/FedEx  a. ___ Express, b. ___ Expedited, c.  ___ Ground (Canada Only), d. ___ U.S. Postal Air,  or e. ___  Other: _____________
*Note that for certain international orders, we may per our customers' requests use USPS Air Mail to send. The postal air mail shipping cost normally is half of UPS Expedited delivery. Please bear in mind that postal delivery is not as reliable as UPS or FedEx delivery. 
If you have your own UPS or FedEx or DHL account number that you would like us to use, please include that number  in #10.

10. How did you hear about our company? Please use the space below to enter your comments or Instructions.



11. Your signature for the above purchase: ____________________________________________________________

When completed, please email this form to Primary Simulation, Inc. at  or fax to (301) 847-0739. We will notify you by e-mail when we receive your order.  THANK YOU VERY MUCH, and we look forward to serving your needs.

We protect your privacy and credit card information!

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Copyrightę 1995 ~ 2016 
PSISM, LLC , dba PSI (formerly  Primary Simulation, Inc. ) 
2963 Mozart Drive, Silver Spring, MD 20904  U.S.A.
Tel:(301) 572-2168,  Fax: (301) 847-0739
10:00AM ~ 6:00PM U.S. Eastern Time