The Diaper Diary

ORDER FORM

   

Make all checks in USA dollars payable to: B. Wilson-Clay/K Hoover JV

12710 Burson, Manchaca, TX  78652        512-292-7227          FAX  512-292-7228          bwc@lactnews.com

www.BreastfeedingMaterials.com

 

 

Name                                                                                                   Phone  (         )

 

Company                                                                    

 

Address                                                                      

 

City                                                     State                Zip                                           Email:

 

$15.00 per pad of 50 color tear-off sheets                                                                                     $13.00 per pad in quantities of 20

 

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Visa/MasterCard #:

 

Card Expiration Date:                                     3 Digit Card Security Number

 

 

Purchase Order Number (or attach PO):

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Shipping Address (Please include Room, Department and Receiving Dock information)

 

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Billing Address (if different) from above:

 

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Number of Pads Ordering  (English)______     (Spanish)______ (French) _______                                                             Price            _______

Pennsylvania residents add 6% State Sales Tax              _______

Philadelphia and Pittsburgh residents add 7% State Sales Tax _______

Texas residents add 6.25% State Sales Tax                   _______

                                                                                                                                                                                Shipping              _______

Total Enclosed                     _______

 

Select Shipping Option:  US Mail _____   UPS ______

US Mail within USA:  $9  1-3  pads,   $12   4-10 pads,    $15  10-20 pads

International shipping:  Please email or call for a quote

UPS rates vary:  Contact us for a quote or provide UPS number__________________________________

                . Shipping costs will appear on the receipt attached to your order.