Order Form

Order Form

University of Richmond Bookstore
Tyler Haynes Commons
University of Richmond, Virginia 23173
Phone : (804) 289-8491
Fax: (804) 289-8044
E-mail: bookstore@richmond.edu

Chemistry Modules of Richmond CD 1.0
Educational Site License
($95.00 includes shipping)

Quantity     x $95.00 =

$

VA residents add 4.5% sales tax

$

Tax exempt number (if applicable)

Total Amount Due

$

Ship to: (Please Print)

Name
Address
Institution
City	State Zip
Phone

Method of Payment

Charge to my (check one)    O MasterCard    O Visa    O Discover

  Expiration Date          -

  Number

  Signature X
(required for credit card purchases)

I enclosed a (check one) O check or O money order
in the amount of $ payable to UR Bookstore

THANK YOU FOR YOUR ORDER

(Bookstore use only)

Quantity x $95.00 =	$
VA residents add 4.5% sales tax	$
Tax exempt number (if applicable)
Total Amount Due	$