Department of Administrative Services

ORDER FORM FOR EDUCATIONAL DIRECTORY

DIRECTIONS: Fill in your contact information, the quantity and check if you are tax exempt or not. Your total will appear below. Then print this page and mail to the address at the bottom with your payment.

DATE:

NAME:

ADDRESS:

CITY: STATE: ZIP:

Quantity:

Price:

Are you tax exempt? YES NO
Total:
Iowa Sales Tax (6%):
Tax Exempt:
Non-Exempt:

Amount Received:

Ck #:

Cash:

Please print then 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. Thank you!