The WomanSource Catalog & Review:

First name:   Last name:  
         Ms   Mrs. Miss Dr.  Mr.

Address

         Title: 
  Organization: 
Street address: 
          City:  State or Prov:  Postal code: 
       Country: 
         Phone:  Fax: 
        E-mail:   
        
Book Quantity
Number of Books Ordered:  at $22.95 per book.  
                                   Total Cost $  
(Add state sales tax)         Total Sales Tax $ 
(Add $1.50 per book shipping)  Total Shipping $          
                                  Order Total $  

Women's Organizations taking part in the Special Benefits Program

 will be billed at $13.75 per book. Minimum order of 5 books.)                   

Method of Payment

Credit card (We will phone you for the number.) 
Enclosed check or money order (Make checks payable to The Launch Pad.)  
Special Benefits Program (Event Name):  

Thank you for your order.

When You Are Done

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Mail-in orders should be sent to: The Launch Pad, 8311 Jackson Springs Rd., Tampa, FL 33615
Orders may be faxed in to 813-249-0105.

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