Print this form,
enter your order and shipping information, and fax to: 801-992-1327
or Mail to: Norman's Historical Data, P.O Box 60635, Reno NV, 89506
DATE OF ORDER:________________________
IF THIS IS A CUSTOM DATA ORDER AND
YOU RECEIVED A CUSTOM QUOTE#: ENTER HERE:_______________
PLEASE TYPE OR PRINT THE DATA DESCRIPTION AND PRICE BELOW .
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
SUB-TOTAL:$____________
SHIPPING AND HANDLING
(if sending via CD) $6.00US within the USA, $12.00US for
Canadian addresses,
$15.00US for all others outside the USA:$____________
If you are in the state of Nevada USA, add Nevada Sales Tax of 7.375%: _________
GRAND TOTAL: $____________
BILLING ADDRESS (Please print clearly or type):
NAME:__________________________________________________________
ADDRESS1:______________________________________________________
ADDRESS2:______________________________________________________
CITY:_____________________________STATE/PROVINCE:_______________
ZIP/POSTAL CODE:______________COUNTRY:______________________
E-MAIL ADDRESS:______________________________________________
COMMENTS: ____________________________________________________________
________________________________________________________________________
PAYMENT METHOD (please check proper line):
CASHIER'S CHECK/MONEY ORDER (Drawn on US$ Funds Only): ________
VISA:________MASTERCARD: ________ AMEX:_______
CC#:____________________________________Expiry Date:__________
CVV/CVC# (Security Code On Your Card):_______
_____________________________________________________
Signature (required for credit card sales):
DAYTIME PHONE (needed in case of order problem):
Country Code:___________Area/City
Code:_________ Phone:_____________________