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Book Order and Credit Card Authorization Form Fort Stanton Cave Sudy Project; 1 Whispering Winds Trail; Placitas, NM 870438861; USA Name of Purchaser:______________________________ Today’s Date:____________ Ship to Address: _______________________________ ________________________________ ________________________________ Contact Information: Email ________________________ Phone #: __________________ Check Number: __________________ American Express: _____ Master Card: _____ Visa: _____ Other: ________________ Credit Card #: __________________ Expiration Date: _________ Security Code: ____ Printed Name on Card: ______________ Signature of Card Holder: _________________ Card Billing Address (if different from above): _________________________________ _________________________________ _________________________________ Quantity of Books Ordered: ___ Est. Shipping: (From Albuquerque, NM USA): __________ Amount Authorized to Charge on Card: $US ________ $AU _________ Order taken by: __________________________________________ Comments: __________________________________________________________ __________________________________________________________________ Note: This form may be scanned and emailed to [email protected] . We can provide estimated shipping costs via email if requested. In the future we expect payment may be made directly on our website as we update our ordering process. Check out [http://FSCSP.org/12MILES/] for additional information.
