FatherSOURCEâ„˘ Order Form TITLE
SUBTOTAL SALES TAX (ID and MD residents add 6%, SD residents add 4%, CA residents add 7.25%) SHIPPING & HANDLING (see page 26) TOTAL If you wish to include additional items, please attach a separate page. BILL TO
PAYMENT Signed & Numbered Purchase Order attached (Businesses or governmental
DATE: _____/_____/_____ NAME:_______________________________
Credit Card (circle one) AmEx / Visa / MasterCard / Discover
ORGANIZATION:_ _____________________ ADDRESS:____________________________ ____________________________________
CITY/STATE/ZIP: ______________________ Expiration
____________________________________ PHONE: ( FAX: (
) _ _____________________ NAME ON CARD
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Check or money order (please make payable to: National Fatherhood Initiative; must be accompanied by official order form)
SHIP TO (if same as bill to, check here )
20410 Observation Drive, Suite 107 Germantown, MD 20876
NAME:_______________________________ ORGANIZATION:_ _____________________
Rush delivery options are available. Additional rush delivery fees apply.
ADDRESS:____________________________ ____________________________________ CITY/STATE/ZIP: ______________________ ____________________________________ PHONE: ( FAX: (
Security Code (an extra 3-4 digit code, located on the front/back of card)
) _ _____________________ ) _________________________
Please call 240-912-1263 prior to ordering. How did you hear about us or our products?
Did a staff member assist you with your order?
If yes, who_____________________________ TO ORDER: www.fathersource.org | (240) 912-1263 | (301) 948-6776 fax
Published on Nov 27, 2012