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ORGANIZATION'S  NAME:
ADDRESS :                     
CONTACT NAME:                      
Home Phone:                             Work Phone:                         E-mail:
SHIPPING: ASAP/ 3- Day ($            ) / 2-Day Delivery ($         ) /Overnight(  $        )
# Booklets:                     +        Free            # Fundraising Cards:             +           Free
Color:  Blue      Red      Green      Purple                                            
Coupons: OK as is       Changes ($30.00)
TOTAL AMOUNT TO BE INVOICED: $
PAYMENT TYPE (CHECK ONE)
  Credit/Debit Card: Visa   Master Card    Discover   American Express Number:                                                   Expiration Date:
POST DATED CHECK ( 30 Days): Fax ACH Form with order and $20 up-front fee
NO HOLD CHECK: Fax ACH Form with order
PURCHASE ORDER: Fax a copy of completed PO with order
Booklets Should Read: 
Logo or Artwork:
Special Instructions/Coupon Changes
Distributor: (name and phone#)