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Political Research Associates

Print Resoures Order Form

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . # of . . . cost
Item Code . . . . Brief Title. . . . . . . . . . . . . copies . . each . . . . Line Total

___________ . ___________________ . . . ___ . . .______ . . ___________

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See Chart Below . . . . . . . . . . . . . . . . . . . . . . . . . .Shipping . . .___________

MA Residents 5% Sales Tax: . . . . . . . . . . . . . . . . . . . . . . . . . ___________

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Order Total . ___________

Payment Enclosed:

__ Check/Money Order (payable to Political Research Associates)

__ Visa . . . . __ MasterCard

Card No.: ______________________________ . Expiration: ___/___

Name on Card: ____________________________________________

Signature: ________________________________________________

Bill to:

Name: __________________________________________________

Organization: ____________________________________________

Address 1: ______________________________________________

Address 2: ______________________________________________

City: ______________________________________ . State: ______

Zip/Mail Code: _________________ . Country: ________________

Daytime Phone (for any questions) ___________________________

E-mail Address: _________________________________________

Ship to:

Name: __________________________________________________

Organization: ____________________________________________

Address 1: ______________________________________________

Address 2: ______________________________________________

City: ______________________________________ . State: ______

Zip/Mail Code: _________________ . Country: ________________

Shipping Cost Chart:

Under $10, add $2.50
Over $10 but less than $20, add $4.00
Over $20, add $6.00

Political Research Associates
1310 Broadway, Suite 201
Somerville, MA 02144.

We accept payment by personal check or credit card (Visa or Mastercard).