Please print or download this form to place an order by e-mail, fax or mail.
You can cut and paste this information and send it by e-mail to DGlassAssc@aol.com.

____ copies at reduced corporate rate of U.S. $395 $295	$ _____
____ copies at reduced non-profit rate of U.S. $225 $195	$ _____
For electronic copies, a $25 discount applies (e-mail address required)	– $ _____
Outside North America, please add $10 for postage per copy for print copies only	$ _____
Total Cost	$ _____

____ copies at discounted corporate rate of U.S. $395 $250	$ _____
____ copies at discounted non-profit rate of U.S. $195 $125	$ _____
For electronic copies, a $25 discount applies (e-mail address required)	– $ _____
Total Cost	$ _____

Name:	___________________________________
Title:	___________________________________
Company:	___________________________________
Mailing Address:	___________________________________
	___________________________________
City/State/Zip:	___________________________________
Country/Postal Code:	___________________________________
Phone:	___________________________________
Fax:	___________________________________
E-mail:	___________________________________
	E-mail address required for orders of electronic copies!

_____	Enclosed is a check or money order payable in U.S. dollars to D. Glass Associates, Inc.
_____	I wish to be billed against Purchase Order Number ________.
_____	Please send information for international wire transfer of funds.

Please send this order form by mail, fax or e-mail, to:

Receipt of all orders will be acknowledged by fax or e-mail. If you do not receive an acknowledgment within five working days, please contact us to confirm receipt of your order. Thank you very much!