The total cost of my order is $__________. Price includes regular shipping and handling and is subject to change.
Personal name: __________________________________ Company name: __________________________________ Street address: __________________________________ City, State, Zip Code+4: __________________________________ Daytime phone including area code: __________________________________ Purchase order number (optional): __________________________________ Check method of payment: ___ Check payable to Superintendent of Documents ___ GPO Deposit Account __ __ __ __ __ __ __ - __ ___ VISA ___ MasterCard ___ Discover __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ / __ __ (expiration date: mm/yy) Thank you for your order! ___________________________________________________________ Authorizing signature 7/2005