Please print form and FAX or Mail to:
Kids In Between
PO Box 1037
Ballwin, MO  63021

Phone:  (800) 481-2799
FAX:  (866)481-2799 Toll Free

Purchase Order Number (if required by your district): _________________

___ Check/Money Order      ___ School PO Attached      __ VISA       __ MasterCard

Card Number: _________________________________________________ Exp. Date: _____/______  VISA/MASTERCARD ONLY

Signature: _______________________________________ Phone: _______________________________________________

Prices good through December, 2008

SOLD TO:                                                                              SHIP TO:

Name:  _________________________________      Name:  ____________________________________

School:  ________________________________     School:  ___________________________________

Street:  _________________________________     Street:  ____________________________________

City:  __________________________________     City:  ______________________________________

State/Zip:  ______________________________      State/Zip:  __________________________________

QTY                                            Title                                            Price        Total

____    _____________________________________________    _____    ______    _______

____    _____________________________________________    _____    ______    _______

____    _____________________________________________    _____    ______    _______

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____    _____________________________________________    _____    ______    _______

____    _____________________________________________    _____    ______    _______

____    _____________________________________________    _____    ______    _______

                                                                                                                                                         

 

                                                                                                                                        Subtotal    ______

Minimum shipping & handling . . . $6.00                                                shipping/handling    ______

For orders $60.00 or over, add 10% of total.                                         TOTAL                        ______

Canadian orders require prepayment and 25% shipping & handling amount.                 

                                                                                         

      

 

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