Note: This is not an
on-line order form.
Please print and mail or fax this form
to:
Northeastern Illinois Planning Commission
233 South Wacker Drive
Suite 800, Sears Tower
Chicago, Illinois 60606
Telephone (312) 454-0400 - FAX (312) 454-0411
Title________________________________________Quantity_____Price
$______Total $______
Title________________________________________Quantity_____Price
$______Total $______
Title________________________________________Quantity_____Price
$______Total $______
Title________________________________________Quantity_____Price
$______Total $______
Title________________________________________Quantity_____Price
$______Total $______
Title______One Year
Subscription________________Quantity_____Price $__325_Total
$______
_______________________________________________Total
Order Amount $ _____
___________________________________________________Less
20% for Subscribers $ _____
_____________________________________________Shipping
and Handling $ _____
_______________________________________________________Total
$ _____
Method of Payment: Check payable to NIPC
enclosed _____
American Express___VISA___ Mastercard ___ Account
No.__________________________
Expiration
date____________Signature______________________________________
Name________________________________________________________
Title_________________________________________________________
Organization__________________________________________________
Address_____________________________________________________
City/State/Zip_________________________________________________
Telephone: _______________________ FAX:
_______________________
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Posted 10-21-02
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