Stipes Publishing Order Form

To order by mail, print out this order form, fill it in and send or fax it with a check or purchase order information to:

Stipes Publishing L.L.C.
204 West University Ave.
Champaign, IL  61820
P.O. Box 526
Champaign, IL 61824-0526

Note: credit card information must include 1) the card number, 2) the name on the card, 3) the expiration date, 4) the address of the cardholder on file with the card company, and 5) the three-digit code on the back of the card.

"Ship to" information "Bill to" information (if different from 
"Ship to" info)
Customer Name:   Customer Name:  
Company:   Company  
Address   Address  
City   City  
State    State   
Zip   Zip  
Phone   Phone  
Fax   Fax  

 
Quantity    Title   Unit Price  Extended Price
       
       
       
       
       
       
       
       
    Illinois Residents: 
Add 8.75% sales tax		  
    Shipping & Handling              $8.00 
    Total: