Order Form

 THE BINOMIAL BOOKSTORE

 A Service of

 THE ROTHSTEIN CATALOG ON DISASTER RECOVERY

 Email to info@rothstein.com, or print and fax to 203.740.7401

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 ORDERED BY: Name ____________________________

 Title _______________________________________

 Organization ________________________________

 Dept./Mail Station __________________________

 Street Address _____________________________

 City ____________ State ________ Zip ________

 Country ___________ Purchase Order # ________

 Phone _________________ Fax _________________

 E-Mail/Internet Address: ____________________

 Shipping Address/Instructions (If Different):

 _____________________________________________

 _____________________________________________

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              ORDER:

 ITEM # / DESCRIPTION / QTY / PRICE / TOTAL /

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

 _______/_____________/_____/_______/_______/

                  Subtotal:          _________

 Handling Charge: 

   ($9. US; $25.00 Canada; 

    25% elsewhere - $25.00 minimum): _________

 Rush Orders Add 15%

   ($25. Minimum)**:                 _________

 Connecticut Customers Add

   6% Sales Tax:                     _________

                           TOTAL:    _________

** For RUSH or Foreign orders, shipping/handling are 

calculated at the time of shipment, but will not 

exceed the amounts shown (and are often lower). 

Please contact us if you would like an estimate 

prior to ordering. Excess shipping/handling charges 

will be credited or refunded.

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              PAYMENT METHOD:

 ___ Check or Money Order Enclosed

       (Payable to ROTHSTEIN ASSOCIATES INC., 

       in U.S. Dollars, drawn on a U.S. Bank)

 ___ Discover Card    ___ American Express

 ___ MasterCard       ___ Visa

 NAME ON CARD ______________________________

 CARD # ____________________________________

 EXP. DATE ________ SIGNATURE ______________

 ___ Wire Transfer (see ordering instructions)

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THE BINOMIAL BOOKSTORE

 A Service of

 THE ROTHSTEIN CATALOG ON DISASTER RECOVERY

 Rothstein Associates Inc.

 4 Arapaho Road

 Brookfield, CT  06804-3104 USA

 Fax       203-740-7401

 Voice     203-740-7444

 E-mail    info@rothstein.com