
| Name | ____________________________________________ |
| Address 1 | ____________________________________________ |
| Address 2 | ____________________________________________ |
| City & State | ____________________________________________ |
| Zip Code | ____________________________________________ |
| Ship by surface or air | ____________________________________________ |
| Email address | ____________________________________________ |
| Phone number | ____________________________________________ |
| Name on card if different than above | ____________________________________________ |
| Credit card number | ____________________________________________ |
| Expiration date | ____________________________________________ |

If mailing a check, please make it out to Paperbacks Plus and send it with this form to:
| Paperbacks Plus | Price = $ 9.95 |
| 6115 La Vista Drive | Surface postage & handling = $ 3.50 |
| Dallas, Texas 75214 | Sales Tax (if in Texas) = $ 1.10 |
| (214) 823-7451 | Total = $14.55 |
If faxing your order with your credit card number, please send to (214) 824-7240.

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