Ordered By: Shipped To (if different):
Name
___________________________
Name ______________________________
Address
_________________________
Address ____________________________
City/State/Zip
_____________________
City/State/Zip ________________________
Phone number or e-mail address (in case we have questions about your order) _______________________________________
Please print clearly when filling
out the order form below.
| Qty | Title or Item Description | Unit Price | Total Price |
|
Subtotal
|
|
|
-10% (BHS
members only)
|
|
| Subtotal |
|
|
+5.5% sales tax (Maine residents only)
|
|
|
*Media Mail/Parcel Post shipping and handling
(see below)
|
|
| *Priority
shipping and handling (see below) |
|
|
Membership dues
|
|
| Total
enclosed (check, money order, or include credit card info.
below) |
|
| For credit card payments, enter
information below, or call your order in at 207-824-2908 /
800-824-2910 |
|
| Card
type (circle one): Visa or MasterCard |
|
| Name
as it appears on
credit card: |
|
|
Card number
(without dashes or spaces):
|
|
| CVC2 or card verification number (on reverse of card as last 3 digits on the strip provided for customer signature): | |
| Expires (mm/yy): | |
|
Signature:
|
|