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BOOK ORDER FORM

UNITED PARENTS AGAINST LEAD (UPAL)

P.O. BOX 24773
RICHMOND, VA 23224
PHONE: (804) 308 -1518
FAX: (804) 562 - 5031
UPAL@JUNO.COM
DATE: ____________________

I would like to order ____ copies of A CHILD IS A TERRIBLE THING TO WASTE, BY ZAKIA R. SHABAZZ

NAME:_________________________________________________________

ADDRESS: _____________________________________________________

TELEPHONE: ___________________________________________________

AMOUNT ENCLOSED:$____________________________________________

($14.95/USD PER BOOK + $5.05 SHIPPING = $20.00)

Credit Card: ___MasterCard  __Visa   __American Express  __Discover

Credit Card #___________________________  EXP:_____________

Name on Card:____________________________  Security Code ______

 

CALL UPAL NATIONAL FOR WHOLESALE AND FUNDRAISER PRICE LIST.