Request for Service

Please forward the completed form to one of the following:

	Email:	operations@polarislearning.com
	Fax:	+1 972-396-9353
	Mail:	Polaris Learning Solutions 13 Heritage Way Allen, TX 75002 USA

Name:	Mr Miss Mrs Ms Dr First: Last:
Job Title:
Company:
Address:
City:	St: Zip:
Country:
Phone: Ext: Fax: Email:
How do you wish to be contacted? Email Phone Mail Have you contacted us before? Yes No
Current Needs:	Education Prof Svcs Information Other (please specify below)
Estimated Timeframe:	0-1 month 1-2 months 2-3 months 3-6 months no rush
How may we assist you?

Thank You!

We strive to provide quick response for our customers, but sometimes technical problems interfere and communications are lost in transit. If you do not receive a response from us within 5 business days (10 business days for mail communications), please contact us again.