Order Form Instructions
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| PRINT: |
Print a copy of this form and complete the form. Please fill
in all areas.
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| FAX: |
Fax a copy of this form and an organization purchase order
to us any time, 24 hours a day.
Fax number is 202-265-8027
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| MAIL: |
Send a copy of this form, and include a check or purchase
order payable to:
The National Alliance for Hispanic Health
1501 16th Street, NW
Washington, DC 20036
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| ITEM# |
TITLE |
QTY |
PRICE
PER |
TOTAL |
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| SHIP
TO: |
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Subtotal |
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| NAME |
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Handling
Charge
($3 per book) |
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ORGANIZATION |
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Shipping
Fee |
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ADDRESS |
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Total |
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CITY/STATE/ZIP |
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TELEPHONE |
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Check or
PO# |
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