northeastern illinois planning commission

Subscription/Publications Order Form

Note: This is not an on-line order form.
Please print and mail or fax this form to:

Northeastern Illinois Planning Commission
222 South Riverside Plaza, Suite 1800
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