Please print and complete this form,

then fax or mail it to Cheltenham Press

Purchaser information

(this must match the name and address for the payment information):

Address____________________________________________________________

City_____________________________

State ____________________________

Zip__________-______

Phone (___) ____-_______

Email________________________________________________________________

Shipping information:   Check if same as Purchaser

Address____________________________________________________________

City_____________________________

State ___________________________

Zip     __________-______

Phone (___) ____-_______

Email__________________________________________________

Item                                         Quantity           Price                             Total

Coping in New Territory        ________EA     $13.95                          _______       

Shipping                                  ________EA     $  2.00                          _______       

                                                                                              Total          _______  

Terms:  _____ Check     _____ VISA      _____ MC

Card Number ________________________________________ Exp (MM/YY)_______/_______                       

Suzanne, please autograph this book for_______________________________

This order is correct in all details and I assume responsibility for payment.

_________________________________________      Date________________________
Buyer's Signature