BRIDWELL LIBRARY ORDER FORM

(Please print order form and fax to 214-768-4295 or mail to Bridwell Library,
Administrative Assistant, PO Box 750476, Dallas, TX 75275-0476).

NAME: _______________________________________________

ADDRESS: ____________________________________________

CITY: ___________________ STATE: _______ ZIP: ___________

COUNTRY: ___________________________________________

PHONE: ______________________________________________

E-MAIL: ______________________________________________

ORDER:    Catalog    CD    Cards    Tote Bag

Title of Item: ____________________________________________

Quantity: __________________________________

Price: $___________________________________

Shipping & Handling: $_______________________

Total: $___________________________________

PAYMENT:    Check    Visa    MasterCard    Money Order

Credit Card Number: _____________________________________

Expiration Date: ____________ CCV Number (3 digits): ___________

Signature: ______________________________________________

If you need further information call 214-768-3483. Thank you for your purchase.