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Contact Information
Organization
Ordered by
Purchase Order #
Telephone Number
Fax Number
E-mail
Bill To
Name
Street
City/State/Zip
Ship To
Name
Street
City/State/Zip
Order Information
Quantity (100 & above) - $ .40 per set*
Quantity (50-99) - $ .45 per set*
Quantity (11-49) - $ .50 per set*
Quantity (under 10) - $2.00 per group of 2 sets*
Just Forms (100 & above) - $ .25 each
Just Brochures (100 & above) - $ .25 each
(*1 set = 1 form & 1 brochure)

THERE IS A $10.00 MINIMUM ORDER FOR ALL CREDIT CARD TRANSACTIONS
Language English and/or
Please indicate how many English sets.
Spanish
Please indicate how many Spanish sets.
Set Quantity sets at $ per set
Just Forms Quantity forms at $.25 each
Just Brochures Quantity brochures at $.25 each
Order Total Amount to be billed. (sets X amount per set = total)
Payment Information
Card Type
Card Number
Exp Date
Special Instructions >>

By clicking 'Order', you are giving MSMS authorization to bill your credit card for the amount indicated as the 'Order Total' above.

 

120 West Saginaw Street, East Lansing, Michigan 48823  Tel: (517) 337-1351  eMail:   msms@msms.org

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