XERCES SOCIETY ORDER FORM
Please print this form, fill it out and send with a check or money order to the address below.

Total $__________

Prices include shipping and handling within the United States using media mail, which can take two weeks. For Priority Mail, add $3 per item. For shipping outside the U.S., please contact us first at info@xerces.org or 503-232-6639.

You may pay with a check, money order, or VISA/MasterCard. For credit card payment, please include the following information:
Credit card number:
Expiration date:
VISA or MasterCard?
Name as it appears on your card and billing address, if different from info below:
Telephone or email (required):
Signature (required):

SHIP TO:

Name_______________________________________________

Address_____________________________________________

____________________________________________________

City_____________________State/Prov________ZIP/Postal Code_____________

Country ____________________

Mail this form along with your credit card information or check/money order made payable to:

The Xerces Society
4828 SE Hawthorne Blvd.
Portland, Oregon 97215 USA