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Brown-Spath & Associates’ Product Order Form

Mail or fax to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116-0721.

Phone: 503-357-9185; Fax: 503-357-9267.

 

Ship to:  (Fill out completely. Please print or type)

 

 

Name/Title

 

Address/Mail Stop

 

Telephone

 

 

 

Company

 

City/State/Zip Code

 

Email

 

Here’s My Order:

 

Qty

Description

Unit Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shipping Charge

Standard Shipping
(USPS Priority Mail)

$6.00 for first product; $2.00 for each additional product

Economy Shipping
(USPS Media Mail)

$3.00 for first product; $1.00 for each additional product

USPS to locations
outside the U.S.

$13.00 for each product

Subtotal

 

 

Shipping

 

 

Total

 

 

 

Payment Method: (All orders from outside the U.S. must be prepaid)

 

¨      Check enclosed

¨      Bill Me – Purchase order number _______________________________________

(PO# required for organizations and governmental agencies)

¨      Charge to:   o VISA          o MasterCard

 

 

 

Name on Card

 

 

Cardholder Signature

 

 

Card Number

 

Expiration Date