Practical Solutions Manual Order Form

FAX or MAIL ORDER FORM

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1. Please Enter the Customer Billing Information (As it appears on your Credit Card):

Email Address:

Name:

Address:

Address line 2:

City:

State or Providence:

Zip or Postal Code:

Country:

Phone:

Fax:

2. Please Enter Ship To Address: (if different from above)

Use the same billing address as the shipping address.

Name:

Address:

Address line 2:

City:

State or Providence

Zip or Postal Code

Country:

Phone:

3. Please Fill in Your Order. (Prices listed in the Online Store)

Item#	Product Description	Price Ea	Qty	Total




		SubTotal
Choose Shipping:		Shipping
		SubTotal
*8.75% Sales Tax on total including shipping (NY Residents Only)*		Sales Tax
	(See Order Info Page for shipping costs)	Total

4. Payment Method:

Mailing with Check payable to Mirror Place, 233 Fillmore Ave., Suite 23, Tonawanda, NY 14150

American Express

Visa

Master Card

Discover Card

Name on Card

Card Number

Exp. Date

CVV2 Code

Signature:

________________________________________

Message or Comments: (If faxing this form you may need to put your comments on a separate page)

Thank You for Shopping with us!