INTERNET ORDER FORM for DEFRAUDING AMERICA _________________________________________________________ _________________________________________________________ SHIP TO: (name):_____________________________________________ (address):__________________________________________ (city): _______________(state): ____(zip):__________ _________________________________________________________ _________Email Address:__________________________________ ITEM Price Quantity Amount DEFRAUDING $28* ________ _______ AMERICA (1) Shipping $ 5.00 first book (U.S.**) $ 1.00 each additional _______ $12.00 case of 12 Sales Tax (CA residents only).................... _______ TOTAL: __________ _________________________________________________________ _________________________________________________________ METHOD OF PAYMENT: ___Check enclosed |___Money Order |___MasterCard/Visa CARD #________ ________ ________ ________ Card Type________________ expiration date_______ Signature:__________________________________________ _________________________________________________________ _________________________________________________________ *Quantity Discounts: 5-11 copies.....$25.50 each 12 or more......$22.50 each **For Shipments outside the US, email Make Checks payable, and send this order form to: David H. Stern, M.D. COPI P.O. Box 4270 Torrance, CA 90510-4270