1. Please print this form and then complete all fields to insure prompt, accurate delivery. Your privacy will be honored. Information will not be shared or sold.
Name ____________________________________________________
City _____________________________ State _______ Zip ________
Telephone _____________________________
Email Address __________________________
Price
$ 12.00
(if applicable) Sales Tax and Shipping
3.00
Subtotal
x Quantity
Total Amount Due
2. Send this form and payment to Charles Pilon at 459 Judith Avenue Roseville, MN 55113. Payment by check only, please. Thank you. Make check payable to Charles Pilon.
3. Thank you.
4. Discounts available on both the book and shipping in lots of 5 books or more. Inquire at c.a.pilon@comcast.net or 651-353-1708.
