Quick Order Form

MBD Publishing

• Postal orders to:    MBD Publishing, P.O. Box 495, Evergreen, CO  80437
• Fax credit card orders to:        303/679-9841
• Name: _____________________________________________________
• Organization Name: __________________________________________
• Colorado Tax Exemption No. (if applicable):  98- __________________
• Colorado Direct Pay Permit (Please provide copy)
• Address: ___________________________________________________
• City: _________________________________State: ____ZIP: ________
• Telephone: _______________E-mail Address: _____________________
• Please send me ____ copies of Who Needs It? at $17.95 each --Subtotal:   $_____              
• Shipping/Handling:

• Sales Tax:

  4.6% Jefferson County
  4.1% rest of Denver Metro
  2.9% rest of Colorado
  	Tax on Subtotal + Shipping: _______
  	Total: _____________

• Payment: [ ] Visa  [ ] Mastercard  [ ] Check payable to MBD Publishing
• Name on Card: _____________________________________________ Cardholder Signaure: ______________
• Card Number: ___________________________   Exp. Date:  ___/_____