Lightbinders Order Form

Name___________________________________________________________________________________

Organization___________________________________________________________________________ 

Purchase Order No. ___________________________

Address________________________________________________________________________________

City________________________________________ County____________________________________ 

State / Country_____________________________ Zip Code__________________________________ 

Phone No. __________________________________ Fax No. __________________________________

E-mail address_________________________________________________________________________


Ship To Address: (if different)

Name___________________________________________________________________________________

Organization___________________________________________________________________________

Address________________________________________________________________________________

City_____________________________________________ County_______________________________ 

State / Country__________________________________ Zip Code_____________________________

Phone No. _____________________________________________________________________________

Method of Payment:	 ___ Check Enclosed (US funds only)

			 ___ Bill me later. (Include PO # above!)

ISBN #       Title                  Quantity          Price          Total

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                        If purchased in California, include CA sales tax @ 8.5%          

                        Plus Shipping and Handling: $4.00          

                        Total ____________