ordform.html

Changeworks Order Form

To Order Directly by Phone: Call 1-800-937-7771
To Order Outside the USA: Call 1-503-228-4972
Or print out form and mail to:
Changeworks/M.A.P.S.
P.O. Box 10616
Portland, OR 97296-0616
Or fax to: 541-223-9117
If you are e-mailing us please include the following:
*Your full name/mailing address/Product title(s)
*Credit card number and expiration date
e-mail address: the changeworks@metamodels.com

NAME (Please Print)________________________________

(CIRCLE ONE) VISA MASTERCARD AMERICAN
EXPRESS

CARD NUMBER________________________________________

EXPIRATION______________DAY PHONE ( )____________

SIGNATURE__________________________________________

MAILING ADDRESS

___________________________________________________

___________________________________________________

___________________________________________________

SHIPPING ADDRESS (if different from mailing)
CHECK ONE Residence__ Commercial__

___________________________________________________

___________________________________________________

___________________________________________________

QTY TITLE LBS COST TOTAL

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

___ _________________________ ____ $____ $_____

SUBTOTAL $_____

SHIPPING FEES $_____
(see ordering info. for shipping fees)
===================================================
TOTAL $
===================================================

Our catalog continues to exist almost entirely because our customers
have wanted their friends and associates to know about our products.
Is there anyone you know that we could send a free catalog to? Thank
You!

NAME_______________________________________________

STREET ADDRESS_____________________________________

___________________________________________________

CITY______________________STATE____ZIP_____________

E-MAIL ADDRESS ?_____________________________________