| SHIP TO: |
BILL TO: |
SCHOOL/LIBRARY: ____________________________________ |
SCHOOL/LIBRARY: ____________________________________ |
ATTENTION: __________________________________________ |
ATTENTION: __________________________________________ |
ADDRESS: ____________________________________________ |
ADDRESS: ____________________________________________ |
CITY: _________________________________________________ |
CITY: _________________________________________________ |
STATE: _____________________ ZIP:
______________________ |
STATE: _____________________ ZIP:
______________________ |
PHONE: _______________________________________________ |
PHONE: _______________________________________________ |
|
DATE: ______________ PO:
_______________________ SIGNATURE:
__________________________________________
|
NO SHIPPING CHARGES! WHY SHOULD YOU
PAY FOR SHIPPING?
|
| I HEREBY AUTHORIZE YOU TO
CHARGE THE AGREED AMOUNT PER MONTH TO MY CHECKING
ACCOUNT MONTHLY WHILE A BALANCE REMAINS.
Signature:
______________________________________
Date: ________________________________
Bank: ___________________________________ Acct. #:
___________________________________________
|
