Up Close Order Form

(Please print this page while we develop our on line ordering)

PA Up Close Brochure Order Form

Item	Quantity	Cost	Amount
Quantity (Order in multiples of 25 only):	_______	$0.60 each	_______
If ordering more than 500 (in multiples of 25)	_______	$0.50 each	_______
Shipping and Handling			$4.00
Total Amount Due			__________
Purchase can be made by Check, Visa, or Mastercard
Name: ______________________________________	Credit Card Number: _________________________
Address: _____________________________________	Expiration Date: _______________________
Address: _____________________________________	Cardholder Name: __________________________
City: ____________ ST: _____ ZIP: _________	Signature: _________________________________

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