 |
Kids
and the Law Order Form |
|
Kids
and the Law Order Form |
Name |
_______________________________________ |
Title |
_______________________________________ |
Organization |
_______________________________________ |
Address |
_______________________________________ |
City |
_______________ State_____ Zip___________ |
Phone |
_______________________________________ |
Spanish/English
quantity |
___ |
x
price ($_____) = |
$_______________ |
Khmer/English
quantity |
___ |
x
price ($_____) = |
$_______________ |
Multicultural
Set quantity |
___ |
x
price ($15.00) = |
$_______________ |
Sub-total |
$_______________ | ||
Shipping |
$____2.00_______ | ||
Total
Payment Enclosed |
$_______________ | ||
Payment
method: |
___ | Check enclosed
- Payable to Adolescent Consultation Services |
|
| ___ | Credit
card (Visa or Mastercard) |
||
| Card number:
_________________________ Expiration Date: ____/____/_________ |
|||
|
|
Signature: ____________________________ | ||
Book Pricing |
|
1- 9 |
$10.00 |
10 - 19 |
$8.00 |
20 or more |
$6.00 |
multicultural set |
$15.00 |
