Transplant Awareness Inc.

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Questions:

Email: tai01@aol.com

Office Phone:
703-825-3290

Transplant Awareness Order Form
http://www.transplantawareness.org/

WHO SHOULD WE SHIP TO?
NAME:
ADDRESS:
STATE / PROVINCE / REGION:
ZIP / POSTAL CODE:
 
QUANTITY PRODUCT  
CODE
DESCRIPTION & SIZE PRICE 
EACH
PRICE
         
         
         
         
         
         
         
         
         
         
Sub-Total
 
Virginia state residents add 5% sales tax
 
Shipping & Handling
  • Inside USA: We will weigh orders Post Office web page will provide cost of mailing, we will add a reasonable cost for shipping supplies.
  • Outside USA: Please email (tai01@aol.com) for details
 
Total:
 
Print and send orders and questions to Claude Brady, TAI President at Email: tai01@aol.com or US Postal:
Transplant Awareness Inc.
P.O. Box 7634
Arlington, Va. 22207.
Payment for you order is accepted, with our thanks, in a variety of forms. We encourage the use of VISA or Master Card for the most efficient "bookkeeping" on your end, and ours.
Please charge: Visa MasterCard      (Please Circle One)

The card #: _____________________________ Exp. Date: ___/___/___

Cardholder name is: _________________________________________

If paying by check please include Check Number:___________________

If we have questions about your order, we will need to contact you:

Phone#: ___________________________________________________

Email Address: _____________________________________________