DNG Order Form

PLACING YOUR ORDER	ORDER FORM FOR DIRECT PAYMENT ORDERS	HOME
(Form can not be completed on-line. Please print first.)
Mail the completed form and your cheque payable to D.N. GOODCHILD to: D.N. Goodchild P.O. Box 2814, Bala Cynwyd, PA, 19004, USA

1. SHIPPING INFORMATION:      Parts 1 and 2 are required for all.

Ship to Name:

Organization:

Street, City:

State, Zip Code: Country:

Telephone: Email:

2. POSTAGE & HANDLING    * Click on P & H to see rate tables.

Enter Comments below. Put $ Amount for Pubs, in right-hand box. Pub Total

* P & H

PA Sls Tx

Misc.

Payment Due

3. PUBLICATIONS BEING ORDERED    Complete or attach your Shopping Cart list.

Item Publication Title Number Qty Unit Price Extension

1

2

3

4

5

6

7

Total for Publications. This is the amount on which P&H is based so also copy this amount to "Pub Total" above.

Thank you for answering this question. How did you find our Web Site?

(Please circle all that apply.) Search Engine (Google, etc)        Museum/Library        Friend        ABE

Ad in: _________________         Link from site named: _______________________
Other source: _____________________________________________________

1. SHIPPING INFORMATION: Parts 1 and 2 are required for all.
Ship to Name:
Organization:
Street, City:
State, Zip Code:			Country:
Telephone:		Email:
2. POSTAGE & HANDLING * Click on P & H to see rate tables.
Enter Comments below. Put $ Amount for Pubs, in right-hand box.			Pub Total
			* P & H
			PA Sls Tx
			Misc.
			Payment Due
3. PUBLICATIONS BEING ORDERED Complete or attach your Shopping Cart list.
Item	Publication Title	Number	Qty	Unit Price	Extension
1
2
3
4
5
6
7
Total for Publications. This is the amount on which P&H is based so also copy this amount to "Pub Total" above.


Thank you for answering this question.		How did you find our Web Site?

(Please circle all that apply.)	Search Engine (Google, etc) Museum/Library Friend ABE

Ad in: _________________ Link from site named: _______________________ Other source: _____________________________________________________