Print then FAX to (507) 645-2995
To print set margins to ¼" and remove header/footer.

314 Washington Street
Northfield, MN 55057-2025
Tel. (800) 783-6743
FAX (507) 645-2995
BILL TO: Name and address where statements are received. Type or print. SHIP TO: Enter if different from BILL TO address. Address can not be a PO Box.
Name Name
Dept/Title Dept/Title
Organization Organization
Address Address
City, State ZIP City, State ZIP
Tel Tel
FAX FAX
PO# eMail address for shipment notification.

Card Number &  Expiration MM/YYYY

 Name on the card/Signature
Item Item
Number		 Quantity Item Item
Number		 Quantity Item Item
Number		 Quantity Item Item
Number		 Quantity Item Item
Number		 Quantity
 1     6     11     16     21    
2     7     12     17     22    
3     8     13     18     23    
4     9     14     19     24    
5     10     15     20     25    

 Personalization

Your Cost

In this space please tell us if you have any special needs and how to personalize your order, or eMail your instructions and graphics to:
imprint@lifeskillsed.com

 Terms:
Net 30 or VISA/MC
Minimum order $100
Personal orders prepaid		 Rack # Quantity Unit Price Extended
       
       

Display Rack Subtotal è

  
Booklet Quantity   Unit Price    
Workbook Quantity   Unit Price    

Qualifies for
 FREE Imprint?

YES   NO
Setup Fee _____
Production Fee _____

Booklet & Workbook Subtotal è

  

MN Only 6½% sales tax or tax exempt #  è

  

Shipping & Handling Œ  _______% è

  

 Personalization Subtotal è

  

Œ Applies to workbooks and booklets only.              

 Total è