

NOTE: Print this Order Form out before submitting it to TDI by fax or mail.
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Quantity |
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Quantity x Weight |
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Sub-Total |
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| A Phone of Our Own | 2 |
$29.95 |
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11.95 | ||||
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10.00 | ||||
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35.00 | |||
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2.00 | |||
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10.00 | |||
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Total Weight: _____ |
Sub-Total $______ | ||||
| Check the Total Weight with the Shipping Chart above and Enter the corresponding Shipping & Handling -------------> |
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| Total Amount: | |||||
NOTE: Print this Order Form out and once completed,
send it to TDI by fax or mail.
Name: __________________________________________________
Company (if applicable): ____________________________________
Street Address: ___________________________________________
City/State/Zip: ____________________________________________
Daytime Phone: _________________ Circle one: TTY Voice Both
Your E-mail Address:
Note: This email address will be stored
internally in TDI's database.
Check here if you wish to receive TDI's eNotes by email:
___ Yes ___ No
Circle one:
VISA MasterCard
American Express
Credit Card #: _____________________________________________
Credit Card Expiration Date: ______/______
Your Name as shown on Card: ________________________________
Your Signature:
____________________________________________
Fax or Mail the completed form to:
TDI
8630 Fenton Street, Suite 604
Silver Spring, Maryland 20910
U.S.A.
301-589-3797 FAX