Print this form and fax to 570-344-8684 or mail to:

1527 Adams Avenue
Dunmore, PA 18509


GENERAL INFORMATION
Name:__________________________________________________
Address:__________________________________________________
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Work Phone:__________________________________________________

Home Phone:

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Fax Number:__________________________________________________

ORDER INFORMATION

Book Title

Qty.KF Order No.Cost Per BookAmount
     
     
     
     
     
     
     
     
     

Tax (PA Residents pay 6% Sales Tax)

 

Shipping & Handling (20% under $50; 10% over $50)

 

Total

 

BILLING INFORMATION

Make Checks Payable to "KIDS FIRST" (Fed. Tax ID: 23-2942170)
Type of Card:_____Visa_____MasterCard
Card Number:__________________________________________________
Expiration Date:

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Name on Card

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Signature:

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