| Name of the book: |
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| How many copies
would you like to purchase? |
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| Name of purchaser: |
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| Name of institution (Library, University etc where relevant) |
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Phone number:
(please
write country code and area code) |
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| Email: |
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| Billing address on credit card: |
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| This book is for: |
Me
Someone else |
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| I would like
the book mailed to: |
| Name: |
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| Address: |
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| My credit card
details: |
| Type of card: |
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Visa
Mastercard
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| Credit Card Number |
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| Expiry date - in order of month and year please |
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| Which country is your credit card issued in |
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Please write
any comments that may help us process your order
eg urgent request, any other queries. |
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