Epi Wit & Wisdom

Step 2 of 3: Provide Shipping Address (If different from Step 1.)

Name:
Company:
Address:
City:
State:	Zip Code:
Country:
Telephone:
Fax:
E-mail:

Step 3of 3: Select A Payment Method

Regular Price	$69.95	each
Shipping & Handling USA & Canada	4.95	each
Shipping & Handling Foreign	20.00	each

A - Payment by Check: Print and complete order form. Send order form and check to:
The Epidemiology Monitor, 2560 Whisper Wind Court, Roswell, GA 30076 USA
All checks must be in US funds drawn on a bank with a US address on the check.

B - Charge credit card:

Mastercard	VISA
Name on credit card:
Credit card account number:
Credit card expiration date:

C - Issuing purchase order for total amount:
P.O.#:
FAX to purchase order to: 770/594-0997

D - Send an invoice to the address in Step 1.

	Enter Security Code