NORTHERN ILLINOIS UNIVERSITY
DIVISION OF STATISTICS

Statistical Consulting Services

Client Request Form

Date:

Name:

Street Address: Apt:

City: State: Zip:

Email:

Affiliation:


Phone: - -

Please provide a brief description of your project:

Source of payment for the services of the SCS?

Additional comments (if any):

Please provide billing information (if different from above):
Billing contact: :

Company name:

Street Address: Apt:

City: State: Zip:


Phone: --


By clicking on the button entitled "Submit Consulting Request Form," I understand and agree to pay the associated fee for the initial consultation ($25 for NIU students and $50 for others), as explained on the SCS website at http://www.math.niu.edu/StatDiv/SCS. I understand that payment is expected at the time of the initial consultation. If Statistical Consulting Services agrees to provide its consulting services to me, payment for services provided to me will be due upon project completion, unless alternative arrangements are made in advance, in writing.