printablepubsform

Union of Concerned Scientists PRINTABLE PUBLICATIONS ORDER FORM Print, complete and fax this form to 617-864-9405, or mail it to Union of Concerned Scientists, 2 Brattle Square, Cambridge, MA 02238-9105, USA. Order
Title	Price	Qty	Amount
_________________________________________________________________	_______	____	_______
_________________________________________________________________	_______	____	_______
_________________________________________________________________	_______	____	_______
________________________________________________________________	_______	____	_______

Subtotal			_______
UCS member's discount: 20% off			(______)
Subtotal			_______
Shipping for orders under $50, add 20%; over $50, add 10%			_______
TOTAL			_______

Shipping Address
Name	_________________________________________________
Street	_________________________________________________
Apt #	_________________________________________________
City	_________________________________________________
State	_________________________________________________
Zip Code	_________________________________________________
Country	_________________________________________________
Telephone	_________________________________________________
Payment
Method	___ Visa ___ Mastercard ___ Check enclosed
Card #	___________________________________________
Expiration	___________________________________________
Billing Address (if different from shipping)
Name	________________________________________________
Street	________________________________________________
Apt #	________________________________________________
City	________________________________________________
State	________________________________________________
Zip Code	________________________________________________
Country	________________________________________________
Telephone	_________________________________________________

Page Last Revised: 08/17/05