Publications Catalog Order Form

Please print or type

Name 	____________________	Title ________________
Company
Address  							Apt./Suite
City  		State  		Zip
Telephone (       )
Fax (       )	E-mail 
Method of payment: - Check/Money order - MasterCard - Visa  - AmEx      
Credit card no. _______________ Expiration date ___/____

Signature_____________________

Shipping/handling charges for US orders:
$10 and under: $2 
$10.01-$25: $4 
$25.01-$50: $5
$50.01-$100: $8
$100.01-$200: $12
Over $200: 5% of total order

For international orders, shipping/handling charges will be determined based on your order.

Item number
Title of publication  _____________________________
Desired format (print/audiotape/braille)
Quantity    	 Price        
Subtotal

Item number
Title of publication  _____________________________
Desired format (print/audiotape/braille)
Quantity    	 Price        
Subtotal

Item number
Title of publication  _____________________________
Desired format (print/audiotape/braille)
Quantity    	 Price        
Subtotal

Shipping/Handling charges
Total
We accept payment by check and credit card. Please make checks payable to: Lighthouse International. And remember to include shipping and handling fees. 

Please fill out this form and mail it with full payment to: 
Lighthouse International, The Sol and Lillian Goldman Building
111 East 59th Street, New York, NY 10022-1202
Attention: Center for Education

Or fax your order to us at (212) 821-9705.

Please allow two to three weeks for delivery. If you have any questions about ordering, e-mail to education@lighthouse.org.