Order Form - Pulp and Paper Safety Association

Print form and send with your check, money order, or purchase order number to the Association address.

If you are making your purchase by credit card, you may either fill in the credit card information on the bottom of this form and submit it as above, or you may call the Association office and we'll be happy to process your order over the phone.

Item	Color	Size(s)	Quantity	Price/item	Total
Golf shirt	white			25.00
Golf shirt	blue stripe			25.00
Golf shirt	green stripe			25.00
Henley shirt	white			15.00
Women's Shirt	pink, blue, green or tan			25.00
Women's Shirt	blue denim			25.00
Men's short sleeve	Blue Denim			25.00
Cap	white	-		10.00
Cap	yellow	-		10.00
Bag	blue	-		10.00
Video: Truck Trailer Loading Safety	Indicate English or Spanish	-		50.00
Video: Avoidable Tradgedy	English only			25.00
Shipping & handling:				Sub total:
1 item	$4.00
2-4 items	$6.00			S/H (see chart):
5-10 items	$8.00			TOTAL:

NOTE: Orders shipping to PO Boxes are sent United States mail

Woman's shirts available in S, M, L, and XL.

To:

Pulp and Paper Safety Association

1370 North Nealon Drive

Portage, IN 46368

From:

Company:

Title:

Address: (NOTE ~ please provide a street address ~ we can't ship to P.O. Box)

Phone:

Do you want FAX confirmation that your order was received? YES NO

FAX Number, if YES:

Do you want EMAIL confirmation that your order was received? YES NO

E-mail Address, if YES:

For credit card purchases:

Circle the card you are using

Card number: _____________________________________ Expiration date: ___________

Name as it appears on the card: ________________________________________________

Your signature: _______________________________________________________________

Thank you for your order!