| Shipping Information |
| Name ________________________________________________ |
| School________________________________________________ |
| Street Address__________________________________________ |
| Billing Address (if different)________________________________ |
| City __________________________________________________ |
| State/Province______________________ Zip/P.C. _____________ |
| Phone _________________________________________________ |
Method of Payment:
Check ___ P.O. ___ Credit Card: Visa ___Master Card ____AmerEx ____ Other ____ |
| Card Number _______________________Expiration Date______ |