College Survival Kit Order Form

Ordered by:

Name ____________________________________________

Street Address _____________________________________

City, State, Zip _____________________________________

Payment: _____ Cash _______ Check ___________ Mastercard ____________ Discover (we do not accept American Express)

Credit Card # _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ expiration date __ / __

Number of Boxes _________ each @ $29.95 + shipping _______________________ Total Amount Due

Ship to:

Name ______________________________________________________

Street Address _______________________________________________

City, State, Zip _______________________________________________

Message to recipient: ________________________________________________________________________________________