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ORDERFRM.TXT
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1980-01-01
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54 lines
Reprint Order Form
Please send to:
Name_______________________________
Address____________________________
___________________________________
Copies requested:
Volume # | Page # | # of Pages
______________|_________________|___________________
| |
______________|_________________|___________________
| |
______________|_________________|___________________
| |
______________|_________________|___________________
| |
______________|_________________|___________________
| |
______________|_________________|___________________
Total # of pages _____________
Cost per page __________X .25
Sub-total_____________________
Add handling and shipping_2.50
Total_________________________
___ Money order enclosed
___ MC ___VISA #____________________________ Expires________
STATEMENT OF USE
I hereby certify that any reprints that I order from
R. L. Hack, will be used for private study or research by my-
self, as intended by Sec. 2(a) of the Copyright Act of Canada.
R. S. c55, s.1.
Furthermore, should I violate the Copyright Act, I
will indemnify R. L. Hack.
Signed_____________________________
Date_______________________________