Shipping Information |
Name ________________________________________________ |
School________________________________________________ |
Street Address__________________________________________ |
Billing Address (if different)________________________________ |
City __________________________________________________ |
State/Province______________________ Zip/P.C. _____________ |
Phone _________________________________________________ |
Method of Payment:
Check ___ P.O. ___ Credit Card: Visa ___Master Card ____AmerEx ____ Other ____ |
Card Number _______________________Expiration Date______ |