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My check for $ ________ is enclosed
Please bill my Credit Card: Visa Mastercard Acct. No. ____________________________________
Exp. Date: ___ Month ___ Year Name on Account:____________________________________
Signature: _____________________________________________
| Name ___________________________________________________ |
| Telephone (___)______________________ |
| Address_____________________________________________________________________________ |
| City___________________________________________State_______________Zip_______________ |
Price of each book includes tax
Mail Order Form To:
DANA - P.O. Box 729 - Nipomo, CA 93444 - 805 929-5679
| Please place my order for the follow book(s) | Quantity | Cost per book |
| _______________________________________________ | ________ | _______________________ |
| _______________________________________________ | ________ | _______________________ |
| _______________________________________________ | ________ | _______________________ |
| _______________________________________________ | ________ | _______________________ |
| _______________________________________________ | ________ | _______________________ |
| _______________________________________________ | ________ | _______________________ |
| Shipping & Handling $5 per book: |
X(quantity)_______ | Total Shipping__________________ |
| Grand Total | _________________________ |