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ORDER FORM for books and articles from NCADRC

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BOOKS (List title or #)                                                                           PRICE

__________________________________________          $ ____________

__________________________________________          $ ____________

__________________________________________          $ ____________

__________________________________________          $ ____________

__________________________________________          $ ____________

__________________________________________          $ ____________

                                                                     BOOK TOTAL:        $ ____________

                                                                                                                                  (Transfer total to second page)

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ARTICLES (List article # & number of pages. No refunds on articles)  

Article #       # Pages                Article #       # Pages                  Article #       # Pages

_______    ________           _______    ________            _______    ________

_______    ________           _______    ________            _______    ________

_______    ________           _______    ________            _______    ________

_______    ________           _______    ________            _______    ________

_______    ________           _______    ________            _______    ________

_______    ________           _______    ________            _______    ________

 

Total pages     ____________                 Total pages     ____________                   Total pages     ____________

(Column #1)                                             (Column #2)                                                (Column #3)

 

TOTAL PAGES FROM ALL THREE COLUMNS  = _____________________  

                 X   $ .20 per page  =  ARTICLES TOTAL $__________________ 

                                                                                                                 (Transfer total to second page)

 

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ORDER FORM TOTALS for books and articles

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BOOKS TOTAL $ ARTICLES TOTAL $

SHIPPING & HANDLING, 2 Day priority USPS with tracking    $

  (Up to $30.50 = $5.50;  $31.00 to $75.00 = $8.50;  $75.01 to 100 = $13.50;  $100.01 to $200.00 = $18.50;

  $200.01+ = $24.50))  -  (Alaska, Hawaii and Out-of-country; actual postage that is charged to us)

  GRAND TOTAL (Checks/M.O. payable to NCADRC) $

Mail this form to NCADRC, PO Box 638, Holland, OH 43528 or fax credit card orders to 419-865-0526

NAME:

FIRM/COMPANY (IF ANY):       

STREET:      

CIT/Y ST/ZIP:  

CREDIT CARD:   V  MC   AE   (circle):   #

CARD EXP: SIGNATURE:

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DONATION BY CREDIT CARD AUTHORIZATION

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  If you would like to make a donation by credit card to the NCADRC, please fill-in the

  information above and the authorization below. All monies go to the operating expenses

  of the organization. Donated monies are not used for wages or fees of any type.

  I hereby authorize NCADRC to debit my credit card listed above for $(fill in amount)

  on a :     

One-time basis      Monthly      Quarterly      Yearly      (Please Circle)

  I further understand that I may revoke this authorization at any time by notifying the NCADRC that I wish

  to discontinue making future donations.

                  Cardholder Name (Print)                                                     Signature