Orion ISO FS Expense Online Order Placement Form

Orion ISO FS Expense Online Order Placement Form
Please review Orion ISO Financial Services Online Ordering Guidelines
1. If your purchase is less than $50 please contact your Family Coordinator before completing the form.
2. If the Participant's support plan is ending in the next 30 days please contact your Family Coordinator.
3. Please submit one form for each online retailer.
4. All items must be approved on the support plan with adequate funding.
5. Orion ISO FS will not process orders from Ebay, Etsy, Temu, membership clubs and any foreign companies.
6. All returns and refunds must be facilitated by Orion ISO FS.
7. Please allow up to 10 business days for online order processing.
8. Orion ISO FS is required to add the MN sales tax equivalent on items purchased from out-of-state companies. This may add an additional cost for the purchase to your budget and will be applied as a separate transaction.
9. Orion ISO FS is unable to process discount codes.
I have read and agree to the above conditions.
Participant Information
Participant Legal Name

Legal First NameLegal Last Name
Responsible Party Legal Name

Legal First NameLegal Last Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Order Information

Please submit one form for each Retailer
How many items are you ordering?
Retailer/Vendor
Item 1
Name of Item
Description of the Item (color, size, item #)
Budget Category (Approved item in Plan)
Cost per Item
Quantity
Item 1 Total
Web Link (to the specific Item)
Screenshot (optional)

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Item 2
Name of Item 2
Description of Item 2 (color, size, item #)
Budget Category for Item 2(Approved item in Plan)
Cost per 2nd Item
Quantity for 2nd Item
Item 2 Total
Web Link (to the specific 2nd Item)
Screenshot (optional)

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Item 3
Name of Item 3
Description of Item 3 (color, size, item #)
Budget Category for Item 3(Approved item in Plan)
Cost per 3rd Item
Quantity for 3rd Item
Item 3 Total
Web Link (to the specific 3rd Item)
Screenshot (optional)

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Item 4
Name of Item 4
Description of Item 4 (color, size, item #)
Budget Category for Item 4(Approved item in Plan)
Cost per 4th Item
Quantity for 4th Item
Item 4 Total
Web Link (to the specific 4th Item)
Screenshot (optional)

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Item 5
Name of Item 5
Description of Item 5 (color, size, item #)
Budget Category for Item 5(Approved item in Plan)
Cost per 5th Item
Quantity for 5th Item
Item 5 Total
Web Link (to the specific 5th Item)
Screenshot (optional)

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Totals
Total for all items
Shipping Information

Ship Order To:
Ship To Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Signatures

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
Responsible Party Legal Name

Legal First NameLegal Last Name
Responsible Party Email
example@example.com
Responsible Party Signature
Date of Signature

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Orion ISO FS Expense Online Order Placement Form

Participant Information

Order Information

Item 1

Item 2

Item 3

Item 4

Item 5

Totals

Shipping Information

Signatures