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| Please fill out the following information and
fax this form to 812-476-4377 or mail it to 4671 Bayard Park Drive,
Evansville, IN 47714. All shipping charges and applicable taxes
are paid by the purchaser. Please contact us at 800-278-0904 or
812-476-1534 or cornerstonevv@earthlink.net
if you have any questions. |
| Name |
Date of Order ___/___ /___ |
| Phone Number |
Email Address |
Date Books Needed ___/___ /___ |
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| Please send me copies of the following textbook(s)
for my LIMEX Course: |
| Author |
Title |
ISBN Number |
Quantity |
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| Payment by Credit Card: |
| [ ] Visa |
[ ] MasterCard |
[ ] Discover |
Expiration Date ___/___ /___ |
| Card Number |
Sign here: |
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| Pre-Payment by Check: |
I wish to pay by check. I understand that my
order will not be shipped until you receive my check. In order to
get my total. I:
[ ] will phone you at 800-278-0904 or 812-476-1534
[ ] will email you at cornerstonevv@earthlink.net. |
| Credit Card
Mailing Address |
Shipping Address |
| Name |
Name |
| Street (no P.O. boxes) |
Street (no P.O. boxes) |
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| City |
State |
City |
State |
| Country |
Postal Code |
Country |
Postal Code |
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| **INCOMPLETE FORMS WILL CAUSE
A DELAY IN PROCESSING YOUR ORDER** |
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| ***BOOKSTORE USE ONLY** |
| Who Filled Order: |
| Shipping Method: |
| [ ] US Mail Book Rate |
[ ] UPS Ground |
[ ] 2nd Day |
[ ] 3rd Day |
[ ] UPS Worldwide Expedited or Express
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Additional Information :
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