El Paso Lighthouse for the Blind

ORDER FORM

- Use for ordering by mail or FAX.
- Please complete Sections 1, 2 and 3.
- Please include appropriate sales tax amount.
- There is no tax on items that are health, home or work related.
- Recreation items are taxable.

Section 1 - Identification

Name ____________________________________

Address __________________________________

City, State, Zip ______________________________

Home Phone ( ) _____________  Business Phone ( ) _____________

Section 1 - Shipping Address (if different from above)

Name ____________________________________

Address __________________________________

City, State, Zip ______________________________

Section 2 - Products

Section 5 - Payment Information

I have enclosed a check for $_____________.

__________________________________ _____________
Signature                                               Date