1997 PRODUCT ORDER FORM

Posted bynena-9-1-1

1997 PRODUCT ORDER FORM

Name: ____________________________________________
Title/Business: ____________________________________________
Address:
(Street address only)		 ____________________________________________
City/State/Zip: ____________________________________________
Phone: ____________________________________________
Fax: ____________________________________________
Membership # ____________________________________________
New Member ____________________________________________
Product Code Quantity Description Cost Each Total Cost
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
__________ ______ ________________________ _________ _________
Shipping & Handling * Subtotal _________
Less than $ 50.00 …………………. $3.50 S & H (if applicable) _________
$50.05 – $100.00 …………………. $5.00 New NENA Membership _________
More than $100.00 …………………. $6.00 TOTAL _________
* Additional Charges
for International Shipping
O Check Enclosed, Payable to NENA (US Funds) O Please Invoice
O VISA O MasterCard O American Express Fax Completed Order Form to (740) 622-2090
Credit Card Number __________________________________ Expires ________
Signature __________________________________

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