b'128SALEM PRESS ORDER FORMPublished & Distributed by Grey House Publishing4919 Route 22, PO Box 56Amenia, NY 12501-0056Phone: (800) 221-1592Fax: (518) 789-0556www.salempress.comcsr@salempress.comDate __________________PO# _____________________________ Sales Representative ________________________________Bill to ____________________________________________________ Ship to _____________________________________________Institution _______________________________________________ Institution __________________________________________Address __________________________________________________ Address ____________________________________________City________________________ State ____ Zip ________________ City________________________ State ____ Zip __________Tel: (____)_________________Fax: (____) _____________________ Attention ___________________________________________E-mail ________________________________________________________________________________________________________qDo not invoice until purchase order is received. Approximate date: ____________________________________________HOLD FOR P.O. NUMBER:q YESq NODOES YOUR LIBRARY WANT PROCESSING:q YESq NOALLOW 4-6 WEEKS FOR ATTACHED PROCESSING.Special Instructions:q CHECK HERE TO AUTHORIZE INSTANT ACTIVATION OF YOUR TITLES ONLINE!WE WILL ACTIVATE YOUR TITLES UPON RECEIPT OF YOUR ORDER SO YOU CAN START USING THEM RIGHT AWAY!Discount schedule for Libraries & Institutions 3-9 Titles 10-35 Titles 36+ TitlesDiscounts are per order and do not apply to prepub prices5% 10% 15%Qty Item No. Description Library Price DiscountPrice TotalSubtotal:Shipping:(add 4%)Order Total:Authorization:'