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HEBREW UNION COLLEGE ANNUAL CREDIT CARD AUTHORIZATION FORM by crunchy

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									HEBREW UNION COLLEGE – JEWISH INSTITUTE OF RELIGION

HEBREW UNION COLLEGE ANNUAL CREDIT CARD AUTHORIZATION FORM

PLEASE COMPLETE THIS FORM (TWO PAGES) AND FAX IT TO: 513-221-3185



I, ___________________________________________________________,

AUTHORIZE THE HEBREW UNION COLLEGE – JEWISH INSTITUTE OF RELIGION TO CHARGE MY

(CIRCLE CARD TYPE):



AMERICAN EXPRESS

VISA

MASTERCARD

DISCOVER



NAME ON CARD: ____________________________________________________

CARD NUMBER: _____________________________________________________

EXPIRATION DATE: __________________________________________________

IN THE AMOUNT OF: _________________________________________________

FOR THE PURPOSE OF: _______________________________________________

SIGNATURE: _________________________________________________________

DATE: _______________________________________________________________

PRINT NAME: ________________________________________________________

IT IS IMPORTANT THAT WE HAVE YOUR EMAIL ADDRESS SO WE CAN CONTACT YOU IMMEDIATELY

IF THERE IS A QUESTION ABOUT YOUR ORDER, AND TO VERIFY YOUR ORDER. PLEASE FILL IN

YOUR EMAIL ADDRESS HERE:

________________________________________________________________________

PLEASE COMPLETE YOUR ORDER INFORMATION ON THE FOLLOWING PAGE AND FAX IT TO THE

NUMBER NOTED ABOVE WITH YOUR PAYMENT. THANK YOU.
ORDER INFORMATION:

This Order is for Volume ______ of the Hebrew Union College Annual (Please fill in volume number);

OR for the following individual article (Fill in Volume Number, Name and Author of Article):

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

OR for the following HUCA Supplement Number, Title, and Author:

________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________



Please tell us your BILLING ADDRESS:

Name: ______________________________________________

Street Address: _______________________________________

City: ________________________________________________

State: _______________________________________________

Zip: _________________________________________________

Country: _____________________________________________



AND your SHIPPING ADDRESS:



_____ Check here if your billing and shipping address are the same

Name: _________________________________________________

Street Address: __________________________________________

City: ___________________________________________________

State:_______________

Zip: ____________________________________________________

Country: _________________________________________________

								
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