Order Form

*** North Carolina Sales Tax - 7% ***

  ***  Mecklenburg Co. Residents Only - 7.5% ***
Name:
Address:
City/State/Zip:
Phone Number/Email Address:
Quantity
Price
Size
 Description Amount
         
         
         
         
         
         
         
         
         
      SUBTOTAL  
     
Tax
SHIPPING & HANDLING
SHADOWGRAPHS Prints   $5.00
SHADOWGRAPHS Cards 1 to 5 cards
6 or more cards		 $2.00
$3.00
Poinsettia Christmas Cards 1 to 3 packages
4 or more packages		 $5.50
$6.50
      TOTAL  

MAKE CHECK OR MONEY ORDER TO: JANE COX HENDRIX SCHOLARSHIP FUND

Questions? Contact: feafasrt@earthlink.net

MAIL TO:
 FRANCES E. APPLE, RT(R) FASRT
5107 MARCELLA COURT
DURHAM, NC 27707
919-489-6666
North Carolina Society of Radiologic Technologists, Inc.