Print
this
form
and
fax
to
570-344-8684
or
mail
to:P.O. Box 308
Scranton, PA 18509
GENERAL
INFORMATION
| Name: | __________________________________________________ | | Address: | __________________________________________________ | | __________________________________________________ | | __________________________________________________ | | Work
Phone: | __________________________________________________ | Home
Phone: | __________________________________________________ | | Fax
Number: | __________________________________________________ |
ORDER
INFORMATION
Book
Title | Qty. | KF
Order
No. | Cost
Per
Book | Amount | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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: | __________________________________________________ | | Name
on
Card | __________________________________________________ | | Signature: | __________________________________________________ |
|