Pump Track Order Form
Send your order and make payment to:
We accept:
Austin Lactation Associates
Credit Cards (Visa/MC)
12710 Burson
Personal Checks
Manchaca, TX 78652
Purchase Orders
512-292-7227 Fax 512-292-7228
E-mail to: dwc@lactnews.com
bwc@lactnews.com
Name:____________________________________________________________
Address:__________________________________________________________
Dept. (Room #):____________________________________________________
City: ______________________________________State: ____Zip:__________
E-Mail:____________________________________ Phone:________________
Credit Card or Purchase Order Number:________________________________
Credit Card Type:___________________________Exp.Date:_______________
Signature:________________________________________________________
Number of copies: _____ at US $99.00 each
$_________
Sales Tax: TX or PA residents only.
Texas (8.25%) = $8.17 or Pennsylvania (7%) = $6.93 $__________
U.S. Shipping and Handling: $4.00 $ _________
Total $__________