| Name: |
|
| Title: |
|
| Organization: |
|
| Mailing Address: |
|
| Phone Number: |
|
| Fax
Number: |
|
| E-mail address: |
|
| Order Blank |
| |
Quantity |
Item
# |
Page
# |
Description |
Price |
Total |
| 1 |
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| 2 |
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| 3 |
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| 4 |
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| 5 |
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| 6 |
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| 7 |
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| 8 |
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| 9 |
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| 10 |
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| Sub-Total |
|
| In CA. Appropriate Tax |
|
| Shipping (see chart below) |
|
| Total |
|
| Note:
For Additional items, please attach your list on a separate piece of
paper. |
| Special order merchandise and merchandise that is embossed or
engraved may not be returned. |
| Please Include Shipping & Handling as Follows: |
|
| If
order is up to $5.00 add |
$ 2.95 |
Full
Payment Enclosed - Check or Money Order |
o |
| If
order is up to $10.00 add |
$ 3.95 |
Please charge my credit card: |
|
| If
order is up to $20.00 add |
$ 4.95 |
Visa |
o |
| If
order is up to $30.00 add |
$ 5.95 |
Master
Card |
o |
| If
order is up to $50.00 add |
$ 6.95 |
American Express |
o |
| If
order is up to $75.00 add |
$ 7.92 |
Discover |
o |
| Over
$75.00 add |
$ 8.95 |
Card
Number: |
| Add
$7.00 extra for registered Mail |
|
Expiration Date: (month / year) _________/_______ |
| Credit Card
Minimum Order $10.00 |
| Credit Card
Signature: |
