WARREN F. BRODERICK
PO BOX 124
, LANSINGBURGH, NY 12182(518) 235-4041 wbroder2@nycap.rr.com
BOOK ORDER FORM
DATE
NAME OF CUSTOMER
ADDRESS
CITY, STATE/PROVINCE ZIP/POSTAL CODE
PHONE/FAX/E-MAIL
BOOKS ORDERED
TERMS OF SHIPMENT
(choose one) DOMESTIC DELIVERY METHOD: MEDIA MAIL PRIORITY MAIL
(choose one) DO YOU WANT INSURANCE (extra expense)? YES NO
Sorry, but we do not ship UPS
or Federal Express at the present time.
ADDITIONAL INSTRUCTIONS OR COMMENTS:
This is not an interactive web-based form, but you may fill in the boxes on your computer. The form must be printed out and mailed to us. Or you can save it as a Word or ASCII text document and e-mail it to us at wbroder2@nycap.rr.com as an attached file.
Send no payment with this form! A quote or pro-forma invoice will be issued.