TAMPA LIGHTHOUSE FOR THE BLIND

MAGNIFIERS & MORE

1106 W. PLATT STREET

TAMPA, FL 33606-2142

 

ORDER FORM:

 

ITEM	DESCRIPTION	QUANTITY	PRICE
		SUB-TOTAL
		TAX .07%
		TOTAL

SHIP TO:

NAME: ____________________________________________________________

ADDRESS: ________________________________________________________

CITY: ___________________________ STATE: ______ ZIP: ________________

 

FORM OF PAYMENT:

CHECK: _______    MONEY ORDER: _______

VISA: ______    MASTERCARD: _______    DISCOVER: _______

CARD NUMBER: _________________________    EXP. DATE: ____________

SIGNATURE: ____________________________________________________

 

MAIL ORDER AND PAYMENT TO:

TAMPA LIGHTHOUSE FOR THE BLIND

MAGNIFIERS & MORE

1106 W. PLATT STREET

TAMPA, FL 33606-2142