** Diploma Frame                      Shipping Charge  $10.95 (each)                    

Remember:  Quantities are limited. Please allow 1 - 2 weeks for delivery.

There are 3 ways to place your order. Print this form:
1) mail it to:  Dana Bookstore, 2848 College Dr., Blair, NE 68008. 
2) phone it to: (402) 426-7254 or 1-800-444-DANA (option 9). 
3) Or FAX your order to:  (402) 426-7922.

Ship to: (Please print)
Name_______________________________________________________

Address_____________________________________________________

City____________________________ State _______ Zip ____________

Phone _______________________ E-mail: ________________________

_____ Check or money order enclosed  (Make checks payable to Dana Bookstore)

Charge:  ___ Visa ___MasterCard ____ Discover
Required for charge orders only:

Account number _____________________________________________

Expiration date ________  Signature ______________________________

3-4 Digit Verification Code: _________________

Billing address for this card (if different than "ship to" address)

Name ____________________________________________________

Address __________________________________________________

City _________________________ State _______ Zip ______________