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ORDER
FORM (GENERAL)
To
order products except videotapes, please print this form and send
with a check or a purchase order (payable to VCU/Partnership for
People with Disabilities). Mail your order to: Partnership for People
with Disabilities, 700 E. Franklin Street, P.O. Box 843020, Richmond,
Virginia 23284-3020. Orders may be faxed to: 804-828-0042. Orders
cannot be taken electronically. Note: this form may print in two
pages.
| Product |
Quantity |
Price
per copy |
Total |
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| Subtotal
|
$_______ |
| Virginia
residents add 4.5% sales tax* |
$_______ |
| Total
|
$_______ |
All
prices include shipping/handling. All prices are subject to change.
Please call for shipping charges for express orde
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Bill
to:
Name:_________________________
Agency:_______________________
Address:_______________________
City:________________
Zip_______
Phone:______________
Fax_______
Payment
Methods:
Check
Enclosed:___________________
Make
checks payable to VCU/Partnership for People with Disabilities
Purchase
Order #:_______________
for
information about orders, please contact:
Valerie
Luther
E-mail: valuther@saturn.vcu.edu
Phone: 804-828-8252
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Ship
to:
Name:_________________________
Agency:_______________________
Address:_______________________
City:________________
Zip_______
Phone:______________
Fax_______
Mail
or Fax Order to:
VCU/Partnership
for People with Disabilities
700 E. Franklin Street
P.O. Box 843020
Richmond, VA 23284-3020
Phone: (804) 828-3876
Fax: (804) 828-0042
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*Virginia
residents please add 4.5% sales tax (does not apply to tax exempt
organizations). Tax exempt organizations, other then public schools,
must enclose a copy of their tax exemption certificate. Note:
Virginia Commonwealth University tax identification number is:
54-6001758.
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