WARREN  F.  BRODERICK

PO BOX 124LANSINGBURGH,  NY  12182

(518) 235-4041    wbroder2@nycap.rr.com

 

BOOK  ORDER  FORM

DATE     

NAME OF CUSTOMER    

ADDRESS   

CITY, STATE/PROVINCE ZIP/POSTAL CODE   

PHONE/FAX/E-MAIL 

BOOKS ORDERED   

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 wbroder2@nycap.rr.com  as an attached file.

Send no payment with this form! A quote or pro-forma invoice will be issued.


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