PSPA Order Form

Please print this page while we develop our on line ordering

PSPA Items Order Form

Item	Cost	Quantity	Amount
Coloring Books	.60¢ each	_______	_______
Coloring Book Bundle (.50¢ each for bundle of 500)	$250.00	_______	_______
Poster	$6.00	_______	_______
PSPA Lapel Pin	$5.00	_______	_______
PSPA Window Decal	$3.00	_______	_______
Shipping and Handling		_______	$4.00
Total Purchase			_______

Purchase can be made by Check, Visa, or Mastercard
Name: _______________________________________	Credit Card Number: ___________________
Address: _____________________________________	Expiration Date: _______________________
Address: _____________________________________	Cardholder Name: _____________________
City: _______________ ST: ______ ZIP: __________

Make checks payable to PSPA or Fax to 724-836-4449
Mail order form to: PSPA P.O. Box 128 Greensburg, PA 15601