| Name: |
________________________________
(Required) |
| Ship to: |
________________________________
(Required) |
|
________________________________ |
|
City
_____________ State ___ Zip _____ (Required) |
| Phone: |
___________________
(Required) |
| |
| Total
Quantity: |
| 8
1/2 x 11= $6.00 __________________ |
| 18
x 24 = $12.00 __________________ |
| |
| Total
Amount Due: _____________ |
| Total
Amount Enclosed: _____________ |
| |
| Method
of Payment: Payable to "UNT Commission on
the Status of Women" |
| ___ |
Cash |
___ |
Check |
___ |
Money Order |
___ |
Purchase Order |
___ |
IDO |
| Mail
to: University of North Texas; Division of Equity and
Diversity; P.O. Box 310937; Denton, Texas 76203 |