LIST
ORDER
FORM


							                                          LIST
ORDER
FORM



Name

 
       
        
        
       
      
       
       
       
        
       
      
  



Address
       
        
        
       
      
       
       
       
        
       
      
  



Phone
 
       
        
        
E‐Mail
Address

      
       
       
        
       
      
  



The
cost
to
produce
a
list
of
the
names
and
addresses
of
Certified
Public
Accountants
and
Public

Accountants
licensed
in
Oregon
is
equal
to
the
amount
necessary
to
prepare
each
list,
including

the
cost
of
materials,
if
any,
and
the
cost
of
staff
time.

Staff
time
shall
be
calculated
at
the

hourly
rate
of
$17
per
hour,
in
quarter
hour
increments
at
$4.25
per
quarter
hour.

The
list
is

available
and
may
be
ordered
in
the
following
forms:





What
you
want:


       1.

   

Active
and
Inactive
CPA/PAs


       2.

   

Active
CPA/PAs


       3.

   

Inactive
CPA/PAs


       4.

   

CPA
Exam
Candidates
           
       
       
       


       5.

   

Successfully
passed
CPA
Exam
Candidates
 


       6.

   

Firms


       7.

   

Municipal
Roster



Geographic
areas
you
wish
included:


       1.

   

All
geographic
areas


       2.

   

Oregon
address
only


       3.

   

Specific
cities:

      
      
       
       
       
        
       
      


       4.

   

Specific
counties:

 
         
       
       
       
        
       
      



How
do
you
want
to
receive
your
list:
          
       
       
       
        Price:


       


       1.

   

E‐mail
to:

 
          
      
       
       
       
        $4.25




If
paying
by
check
or
money
order:
 
           If
paying
by
Visa
or
MasterCard:

OREGON
BOARD
OF
ACCOUNTANCY

                   OREGON
BOARD
OF
ACCOUNTANCY

UNIT
05
 
 
            
        
       
      3218
PRINGLE
ROAD
SE
#110

PO
BOX
4395
 
          
        
       
      SALEM
OR
97302‐6307

PORTLAND
OR
97208‐4395
 
                
      FAX:
503.378.3575



Account
Number

        
        
       
      
       
       
       
3‐digit
code
 
        
  

Expiration
Date


          
         
         
   Amount
to
be
Charged:
    
     
      
       


Signature

 
      
        
         
         
   
     
      
      Date
 
     
      
       

Fees
are
not
refundable.

If
you
have
questions,
please
contact
David
Hunter
at

(503)
378‐2235
.


May 2004
Data:Lists:Lists:Request Forms:Order Form.doc