Health Insurance Book Order Form |
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Aji Publishing LLC
P.O. Box 2207, Chapel Hill, NC 27515
www.BestHealthInsuranceBook.com
ORDER FORM
Billing Information
Company:___________________________ Contact Person:___________________________________
Address: _________________________________________City: __________________State: _____ Zip:_________
Office #:______________________ Fax #:______________________ Email:________________________________
Ship To Address
Company:___________________________ Contact Person:___________________________________
Address:_________________________________________City: __________________State: _____ Zip:__________
Office #:______________________ Fax #:______________________ Email:________________________________
| Item |
Product # |
Description |
Unit Amt |
# of Item |
Total |
| Book |
0979478103 |
Get a Good Deal on Your Health Insurance Without Getting Ripped-Off |
$17.95 |
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| Book |
0979478111 |
Caroleena's Tuscan Kitchen - Cookbook |
$14.95 |
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| S/H |
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Shipping/Handling: $4.50/order + $.50/book (Priority Mail) |
$4.50 + .50¢/book |
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TOTAL |
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Bill/Invoice Me: P.O. #________ (Qualified government, non-profit, and corporations)
Visa, MC, Discover, Amex (Circle One)
Name on Card_________________________________Card #______________________
Expiration Date:___________________ Code ______ Check/MO Enclosed: ______________
Thank you for your order!
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Last Updated ( Saturday, 08 December 2007 ) Written by Jonathan Pletzke |
