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FatherSOURCE™ Order Form TITLE

item No.

QTY.

PRICE EACH

TOTAL

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:_______________________________

units only.)

Credit Card (circle one) AmEx / Visa / MasterCard / Discover

ORGANIZATION:_ _____________________ ADDRESS:____________________________ ____________________________________

CARD number

CITY/STATE/ZIP: ______________________ Expiration

____________________________________ PHONE: ( FAX: (

) _ _____________________ NAME ON CARD

) _________________________

E-MAIL: _____________________________

SIGNATURE

check here to join our e-mail list for exclusive sales and promotions!

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)

) _ _____________________ ) _________________________

E-MAIL: _____________________________

Please call 240-912-1263 prior to ordering. How did you hear about us or our products?

newsletter

e-mail

website

training

exhibit

PSA

word-of-mouth

other________

Did a staff member assist you with your order?

yes

no

If yes, who_____________________________ TO ORDER: www.fathersource.org | (240) 912-1263 | (301) 948-6776 fax

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Fall/Winter 2012 FatherSOURCE Catalog  
Fall/Winter 2012 FatherSOURCE Catalog  

The latest fatherhood skill building resources from National Fatherhood Initiative.

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