| 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. #:
___________________________________________
|