www.greyhouse.com (800) 562-2139 4919 Route 22, PO Box 56 Amenia, NY 12501-0056 Grey House Publish ing 4919 Route 22 PO Box 56 Amenia, NY 12501-0056 www.greyhouse.com (800) 562-2139 ORDER FORM Mail, Fax or Email to: Grey House Publishing w 4919 Route 22, PO Box 56 w Amenia, NY 12501-0056 (800) 562-2139 w (518) 789-8700 w FAX (518) 789-0556 w firstname.lastname@example.org w www.greyhouse.com Date: Purchase Order# Bill to Organization: Ship to Organization: Attention: Attention: Address: Address: City/State/Zip: City/State/Zip: Phone: Fax: Email: Special Instructions: ORDER TWO OR MORE TITLES AND GET FREE SHIPPING! Qty. ISBN Title List Price Total • Library, bookstore, wholesaler, distributor, and institution orders with an authorized signature and a purchase order will be billed. All other orders must be prepaid before shipment. • *Shipping: for U.S. shipments - 1 Title: $15.50, 2+ Titles: FREE • For shipments outside the U.S., please call (518) 789-8700 for a rate quote. • Prices subject to change without notice. Subtotal: Sales Tax (NY & FL): Shipping & Handling* Total PAYMENT OPTIONS q Ship with Invoice q Credit Card q MasterCard q Visa q American Express Card# Expiration Date: Name on Card: Billing Zip Code: Security Code: Authorization Signature: THANK YOU FOR YOUR ORDER!