Pine View Press Printable Order Form

Print this form and then either fax it with your shipping and payment info to (508) 765-1963, or mail it with your payment info or check to:

Pine View Press
42 Central Street
Southbridge, MA 01550

I wish to order _______ copies of "Nomadin", and _______ copies of "NiDemon" at the price of $12.95 per copy. If shipping to Massachusetts, 5% sales tax must be added to the total order.

Shipping Info:

Name: ____________________________________________________

Address: __________________________________________________

City: ______________________________________________________

State/Province: _____________________________________________

Zip/Postal Code: ____________________________________________

Country: ___________________________________________________

Telephone: _________________________________________________

E-mail: ____________________________________________________

Billing Info:

Card Type (circle one):

 VISA    MASTERCARD   DISCOVER   AMEX

Card Number: _________________________________

Card Expiration date: ________________________

ORDER DETAILS:

QTY: __________ Books at $12.95 = $ __________

Massachusetts residents add 5% sales tax: $ ________

Shipping costs (see below): $ _____________

Order Grand Total: $___________