WARREN F. BRODERICK
PO BOX 124, LANSINGBURGH, NY 12182
(518) 235-4041 firstname.lastname@example.org
BOOK ORDER FORM
NAME OF CUSTOMER
CITY, STATE/PROVINCE ZIP/POSTAL CODE
TERMS OF SHIPMENT
(choose one) DOMESTIC DELIVERY METHOD: MEDIA MAIL PRIORITY MAIL
(choose one) DO YOU WANT INSURANCE (extra expense)? YES NO
Sorry, but we do not ship UPS
or Federal Express at the present time.
ADDITIONAL INSTRUCTIONS OR COMMENTS:
This is not an interactive web-based form, but you may fill in the boxes on your computer. The form must be printed out and mailed to us. Or you can save it as a Word or ASCII text document and e-mail it to us at email@example.com as an attached file.
Send no payment with this form! A quote or pro-forma invoice will be issued.
Read Terms of Business
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