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Ordering Instructions

Name_______________________________________________________________________________

Shipping Address____________________________________________________________________

City, State, Postal Code_______________________________________________________________

Country_____________________________________________________________________________


Name
_______________________________________________________________________________

Billing Address
_______________________________________________________________________

City, State, Postal Code_______________________________________________________________

Country_____________________________________________________________________________

Phone / e-mail_______________________________________________________________________

Code Title Price # Total
         
         
         
         
         
         
         
         
         


Number of Books   _____                  

Total Amount for Books   _______________

Colorado Residents add 2.9% sales tax   _______________

Shipping & Handling (calculate using the online order form)   _______________

Grand Total   _______________

 

Credit Card Information
Please charge my order to:  _____VISA 
  _____MasterCard _____DISCOVER

Credit Card #:________________________________________  Expiration:_____/_____

Signature:________________________________________________________________ 
 
Shipping & Handling
  
Additional Payment Methods
     Credit Card: E-mail your order to the Order Desk and phone in your credit card information.
     Personal Check: Make checks payable to 21st Century Books.

Mail this form to:
21st Century Books

Post Office Box 2001
Breckenridge, CO 80424-2001

Phone/Fax: (970) 453-6692 (8:00 AM to 5:00 PM Mountain Time)