The total cost of my order is $__________. Price includes regular shipping and handling and is subject to change.
Personal name: __________________________________
Company name: __________________________________
Street address: __________________________________
City, State, Zip Code+4: __________________________________
Daytime phone including area code: __________________________________
Purchase order number (optional): __________________________________
Check method of payment:
___ Check payable to Superintendent of Documents
___ GPO Deposit Account __ __ __ __ __ __ __ - __
___ VISA ___ MasterCard ___ Discover
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
__ __ / __ __
(expiration date: mm/yy) Thank you for your order!
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Authorizing signature 7/2005