INTERNET ORDER FORM for VOTESCAM _________________________________________________________ _________________________________________________________ SHIP TO: (name):_____________________________________________ (address):__________________________________________ (city): _______________(state): ____(zip):__________ _________________________________________________________ __________Email Address:_________________________________ ITEM Price Quantity Amount VOTESCAM $9.95 ________ _______ Shipping $ 3.00 first book (U.S.**) $ 1.50 each additional _______ Sales Tax (CA residents only).................... _______ TOTAL: __________ _________________________________________________________ _________________________________________________________ METHOD OF PAYMENT: ___Check enclosed |___Money Order _________________________________________________________ _________________________________________________________ *Quantity Discounts: 5-11 copies.....$ 8.00 each 12 or more......$ 7.50 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