2010 BSRF Order Form - Print Out and Mail or Fax

Borderland Sciences
Post Office Box 6250
Eureka, California, U.S.A., 95502
Phone 707- 497- 6911
Fax 815- 301- 8655

Name:______________________________________________

Address:___________________________________________

City:__________________State:___Postal Code:_______

Country______________________

Daytime Phone:_____________________________________

e-mail:_____________________________________

QTY	ORDER No.	Title or Description	PRICE	TOTAL








Method of Payment: __Check or Money Order Enclosed __Charge it to my: ___Visa, ___Mastercard Credit Card Number: ___________________________________ include all digits Expiration Date: ____/____ Print Name Exactly As On Card: __________________________ Signature as on Card: ___________________________________ Three-digit Security Code__________			Subtotal	.
			CA Residents add 8 ¼ % sales tax	.
			Postage	.
			Order Total	.
			Journal Subscription	.
			Grand Total	.

Shipping Instructions : Check One Please

____Ship Book Post/Surface Rate
____Ship Priority (USA Only
____Air Mail (Outside the USA)
____Insurance

-----------------for office use only-----------------