RCL Benziger Catalog 2017 | Page 154

Order Form

BILL TO *
Name : _________________________________________________ School / Parish :________________________ Diocese :__________ Position : _______________________________________________
RCL Benziger Account #_______________________ ( if applicable ) Street :____________________________________________
City : ________________________ State : ______ Zip : __________ Phone : (_____) __________________________________________ Fax : (_____ ) ____________________________________________ E-Mail : ________________________________________________
( By providing your e-mail address we can notify you when your order has been shipped .) * Parishes or schools may be billed subject to credit approval . Individuals must prepay by check or credit card .
CREDIT CARD
Check Enclosed
Name on Card : _________________________________________ Expiration Date : ________________________________________ Account #:________________________ Security Code : _______
Signature : ______________________________________________ ( Required for Credit Card )
SHIP TO
Name : _________________________________________________ Institution :______________________________________________ Position : _______________________________________________ Street :_________________________________________________ City : ________________________ State : ______ Zip : __________ Phone : (_____) __________________________________________ E-Mail : ________________________________________________
Please total this section when payment is enclosed . THANK YOU .
Product Total
Shipping / Handling @ 11 % ( minimum $ 5.00 )
Grand Total
$ ________________
$ ________________
$ ________________
Product Must Arrive By _______ /_______ /_______ ( Allow 7 to 10 business days )
Would you like to receive RCL Benziger ’ s E-newsletter ? Yes
No
Qty . Product # Description Price
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8805 Governor ’ s Hill Drive , Suite 400 • Cincinnati , OH 45249