PRINT OUT THIS ORDER FORM
and fax to 845-254-4476, or call in toll free 1-800-325-2665, or mail to
PURPLE MOUNTAIN PRESS, LTD., PO Box 309, Fleischmanns, NY 12430-0309
or click here to e-mail your order.

Payment for orders shipped within New York State must include sales tax.
What is my tax rate?
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Sold to:

Name ___________________________________________________________
Address ________________________________________________________
City ___________________________________________________________
State/Province ___________________________ZIP/PC________________

Ship to (if different):

Name ___________________________________________________________
Address ________________________________________________________
City ___________________________________________________________
State/Province ____________________________ZIP/PC_______________

___ Gift wrap. Gift message ___________________________________
Qty/Title/Price
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_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
Shipping in the US: $3.50 per order (via USPS Media Mail) . . . . . . .
Extra shipping for Priority Mail $3.50 for the 1st book,
$1 for each additional book. . . . . .. . . . . . . . . . . . . . . . . __________
Extra shipping outside USA: inquire for surface or air rates. . . . . . __________
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Subtotal . __________
. . . . . . . . . . . . . . . . . . . . . . . . .Sales Tax (NYS res.) . __________
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL . __________

Method of payment: ___Check/money order ___ VISA ___ M/C ___ Discover

Acct. ______________________________________ Exp. Date _______
S.C.*_________

Signature ____________________________________________________

*The security code is the three-digit code on the back of the card. ===============================================================================================

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