Quantity:_________
Price per unit:______________
(US $21.00 in developing countries;
$35.00 in developed countries) Total
(in US dollars)
Subtotal:_____________
S&H $6.00 each:__________
TOTAL:_____________
Name:________________________________________________________________________
Address:______________________________________________________________________
City:_____________________________________State/Prov:______________________________
Postal/Zip Code:___________________ Country:______________________________
Tel (include country and city codes):_________________________Fax:_____________________
Email:_________________________________________________________________________
If a receipt is required please check: Yes_____ No_____
Order must be paid in US dollars using any of the following:
1. Personal check drawn on a US bank made payable to IAHPC
2. Travelers Check or Money Order in US $ made payable to IAHPC
3. Wire transfer to Bank (Call or write to ldelima@iahpc.com for information)
4. Credit Card (check one):
Visa / MasterCard / American Express/
Account Number____________________________________________________________
Expiration Date (M/Y)________/_________
Name on Card:_____________________________________________________________
Signature__________________________________________________________________
Please click the Submit Button below. If you pay by credit card, you will receive a confirmation via email.
If you prefer to pay using a check or money order, fill out and print this form and send it to:
Liliana De Lima
IAHPC Press
5535 Memorial Dr Suite F-PMB 509
Houston TX 77007
USA
Thank you!
IAHPC Press