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Discover  Your  Library   P S A Order Form
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Discover Your Library P S A Order Form

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  • 1. “Discover Your Library” PSA Order Form Name: _________________________________________________ Date: ___________________________________ Library/Organization Name: _______________________________________________________________________________ Phone: _____________________________________ E-Mail: _________________________________________ Ship To: please note shipments cannot be delivered to a PO Box Name: Address: City: State: Zip: All orderS muST be prepAid before proceSSing. pleASe Send ThiS form wiTh check To: Jennifer Pavlik Douglas County Libraries 100 South Wilcox Castle Rock, CO 80104 pleASe mAke checkS pAyAble To: douglAS counTy librArieS foundATion or fAx ThiS form wiTh crediT cArd number To: 303-688-7655 q Visa q Master Card q American Express q Discover CC#: ______________________________ Expiration Date: ____/____ (MM/YY) Cardholder Name:________________________ Signature Of Cardholder: ________________________ Prices below include the cost of dubbing and shipping via UPS ground. Allow 2-4 weeks for delivery. • opTion 1: Beta SP or DVCam with 2 generic Beta SP DVCam PSAs (30 sec. & 60 sec.): $95.00 Quantity: _______ x $95.00 q q • opTion 2: Beta SP or DVCam with 2 Customized PSAs (30 sec. & 60 sec.): $145.00 includes website and/or Library name Quantity: _______ x $145.00 q q Total: $__________ inSTrucTionS for cuSTomizATion: Library’s name or website can be added to the beginning and/or end of the PSA. Name or Website at beginning: _____________________________________________________________________ Name or Website at end: __________________________________________________________________________ For billing questions or questions about customizing the PSAs for your library, please write to Jennifer Pavlik at jpavlik@dclibraries.org DouglasCountyLibraries.org CO/JP308

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