PfEFFER Order Form |
| Name |
___________________________________________________ |
Company |
___________________________________________________ |
Address |
___________________________________________________
___________________________________________________ |
| City
|
____________ State _____ Zip _______ Country __________ |
Phone |
___________________________________________________ |
Fax |
___________________________________________________ |
E-mail |
___________________________________________________ |
|
|
Amount |
$ __________________ |
Card Number |
_____________________________ Exp. Date __________ |
Signature as shown on card _____________________________
|
Make checks payable to the Kansas Geological Survey
|
|
|
Kansas Residents, please contact
Publication Sales for specific sales tax to be charged. |