ORDER FORM FOR EDUCATIONAL DIRECTORY

DATE:

NAME:

ADDRESS:

CITY:STATE: ZIP:

Description	Quantity	Unit Cost Tax Exempt $11.50	Unit Cost Taxable $12.19	Total Cost
2007-2008 Educational Directory
			TOTAL PAYMENT:

Amount Received:	Ck #:	Cash:

PUBLICATION SALES

Mail to:

Customer Service Center
Department of Administrative Services
Hoover State Office Building, Level A
1305 E Walnut
Des Moines, Iowa 50319

Please make checks payable to: Department of Administrative Services

We do not accept purchase orders.

For Questions Please Call: 515-242-5120 or Fax: 515-242-5974

Please print then mail or fax to the Customer Service Center