Csg Order Form For Individuals-order 3
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CHEON SEONG GYEONG ORDER FORM FOR INDIVIDUALS SEND THIS ORDER FORM WITH YOUR PAYMENT TO: Chicago District Headquarters, Attention: “Cheon Seong Gyeong Order 2” 7450 N. Sheridan Road • Chicago, IL 60626 • Telephone: 773-274-7441 ORDERS WITH PAYMENT MUST BE RECEIVED BY APRIL 30, 2007 Number of Books by Language: English
(
)
French
(
)
Spanish (
)
Mongolian (
)
Chinese (
)
Taiwanese (
)
Thai
)
Ukrainian (
)
(
Romanian (
)
Name
_____________________________________________________________________
Street Address
_____________________________________________________________________ _____________________________________________________________________
City, State, Zip
_____________________________________________________________________
Telephone
_____________________________________________________________________
E-mail
_____________________________________________________________________
Total Number of Books
_____ x $225.00 = Total Order Amount $ __________
Payment Method: Personal Check (payable to HSA-UWC)
Credit Card
The CIG Settlement Fund donation from my purchase should remain in the US.
YES
OR Please send the CIG Settlement Fund donation from this purchase to: ____________________________ (Nation) Credit Card Authorization Name As it Appears on the Card _________________________________________________________ Billing Address
_____________________________________________________________________ _____________________________________________________________________
City, State, Zip
_____________________________________________________________________
Telephone
_____________________________________________________________________
Total Order Amount $ __________ + Processing Fee (3%) = $ __________ Credit Card Type: Visa
Mastercard
Discover
Amex
Card No: __________________________________________________ Signature ______________________________________
Expiration Date: __________
(
)
French
(
)
Spanish (
)
Mongolian (
)
Chinese (
)
Taiwanese (
)
Thai
)
Ukrainian (
)
(
Romanian (
)
Name
_____________________________________________________________________
Street Address
_____________________________________________________________________ _____________________________________________________________________
City, State, Zip
_____________________________________________________________________
Telephone
_____________________________________________________________________
_____________________________________________________________________
Total Number of Books
_____ x $225.00 = Total Order Amount $ __________
Payment Method: Personal Check (payable to HSA-UWC)
Credit Card
The CIG Settlement Fund donation from my purchase should remain in the US.
YES
OR Please send the CIG Settlement Fund donation from this purchase to: ____________________________ (Nation) Credit Card Authorization Name As it Appears on the Card _________________________________________________________ Billing Address
_____________________________________________________________________ _____________________________________________________________________
City, State, Zip
_____________________________________________________________________
Telephone
_____________________________________________________________________
Total Order Amount $ __________ + Processing Fee (3%) = $ __________ Credit Card Type: Visa
Mastercard
Discover
Amex
Card No: __________________________________________________ Signature ______________________________________
Expiration Date: __________
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