Order Form

Download as fillable PDF

Prices current through August 30, 2018.

To order Institute products, please mail or fax this form to:

Publications Office, Institute on Community Integration, University of Minnesota,
109 Pattee Hall, 150 Pillsbury Dr. SE, Minneapolis, MN 55455
(612) 624-9344 (fax)

Payment by (please check one):

___ Check or Purchase Order (enclosed, payable to University of Minnesota, tax ID#416007513)

___ Credit Card (you will be invoiced by mail and pay invoice online with credit card/P-card)

Questions? Contact us at (612) 624-4512 (voice), icipub@umn.edu

Note: This form may print in two pages.

Publication (please print full title):
Price per copy
Quantity
Total price
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Sub-Total
$ __________
Sales Tax (MN customers only. Does not apply if tax-exempt. See note below*)
$ __________
TOTAL
$ __________

Purchase Order/Check Number: _____________________________
(Do not send credit card number)

Prices include shipping in the U.S. by Media Mail (typical delivery time 1-2 weeks); for information on rush shipping, contact the Publications Office. Tax-exempt Minnesota organizations: Please provide copy of exemption certificate if first time ordering. We reserve the right to limit quantities on complimentary items.

Name __________________________________________________________

Address _________________________________________________________

Address _________________________________________________________

City ________________________________ State _______ Zip ____________

E-mail _______________________________ Phone _____________________

*For Minnesota customers who are not tax exempt, determine the sales tax rate to apply to your order by going to z.umn.edu/mnsalestax.

End of Order Form