Phone #: Toll Free 800 423 4525
Date _______________________
Bill to: Ship to:
Name _____________________________ Name _____________________________
Address ___________________________ Address ___________________________
__________________________________ __________________________________
State/Zip___________________________ State/Zip___________________________
Daytime Phone ______________________ Daytime Phone ______________________
Quantity Name of Book/Tape Price
_________ _______________________________________________ $____________
_________ _______________________________________________ $____________
_________ _______________________________________________ $____________
_________ _______________________________________________ $____________
_________ _______________________________________________ $____________
_________ _______________________________________________ $____________
SubTotal $________________
UPS Shipping $________________
VT residents add 5% Sales Tax $________________
TOTAL $ ________________
UPS Shipping: $7.00 for first item, $3.00 each thereafter.
All payments must be made in U.S. dollars, drawn on a U.S. bank.
All shipments are via UPS: please provide a street address.
__ MasterCard __ VISA
# ______________________________
Expires Mo_______Yr__________
Signature _________________________