Print this form and then FAX to number below.

                                   Photos on CD-ROM Order Form -- Third Edition

                                              Order by phone, mail, E-Mail  or FAX.
                      Note when paying by credit card that this is NOT a secure site.

Mail or FAX your order and make payment to:                          We accept:
Barbara Wilson-Clay                                                                         Visa/Mastercard
12710 Burson                                                                                      Personal Checks
Manchaca, TX 78652                                                                         Purchase Orders
512-292-7227 Fax 512-292-7228                                                     EIN# 74-2923741
E-mail to: bwc@lactnews.com


Name:______________________________________________________________

 

Address: ___________________________________________________________

 

Dept. (Room #):______________________________________________________

 

City: ________________________________________State:____Zip:__________

 

Phone: ________________________ E-Mail: _____________________________

 

Credit Card or Purchase Order Number:________________________________

 

Credit Card Type:___________________ Exp. Date:______________________

 

Signature:_________________________________________________________

 

Number of CD's: ____ at  US $55.00 each - Individual Price                   $_______

Number of CD's: ____ at  US $150.00 each - Institutional Rate              $_______

 

Sales Tax: TX or PA residents only.
Texas (8.25%) or Pennsylvania (7%)                                                             $_______

 

U.S. Shipping and Handling:   $6.00 for 1
                                                         $9.00 for 2 to 9
                                                     $12.00 for 10 to 20                                          $________

 

Total                                                                                                                        $________

 

Please inquire concerning international shipping rates and bulk orders.