Publications Order Statement by nfy87895

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									                                                        Publications Order Statement
                                                                       Order Department
                                                                    500 W. Int'l Airport Rd., Ste. A
                                                                        Anchorage, AK 99518
                                                            Phone: (907) 276-LUNG or 1-800-LUNG-USA
                                                             Fax:(907) 565-5587 E-mail: info@aklung.org
                                                                          www.aklung.org


Date:       9/28/2006                       PO #:
BILL TO:                                    SHIP TO:




                                            Credit Card #                                  Exp Date

Phone:                                      Signature                   phone                  Bill Me


                                                                           Price Per
   Item #   Quantity             Title/Description                       Hundred/Each           Total




                                                          Subtotal
                                               Shipping & Handling                                $15.00
                                                                                  Total:

Please note that if orders cannot be filled with stock on hand they must be
special ordered and are not returnable.

								
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