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<title>HACU Publications</title>
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<td width="18%" valign="top" height="159"></font><a href="default.htm"><img
src="images/smalllogo.gif" alt="HACU Home" border="0" align="top" WIDTH="132" HEIGHT="203"></a></td>
<td width="82%" height="159"><p align="center"><big><strong><big><big>Publications Order
Form</big></big></strong></big><font face="helvetica"></p>
<p align="center"></font>Print this page, fill it out, and return to HACU via FAX or mail.</td>
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<td width="64%"><b><i><u><small>PUBLICATIONS</small></u></i></b></td>
<td width="7%"><small><u><i><b>COST</b></i></u></small></td>
<td width="22%"><small><u><i><b>QUANTITY</b></i></u></small></td>
<td width="34%"><small><u><i><b>TOTAL</b></i></u></small></td>
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<td width="64%"><small>HACU Membership Directory</small></td>
<td width="7%"><small>$40.00</small></td>
<td width="22%"> </td>
<td width="34%"><small>$</small></td>
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<td width="64%"><small>The Voice (Monthly Newsletter) Hard Copy</small></td>
<td width="7%"><small>$12.00</small></td>
<td width="22%"><font size="1">1-Year Subscription</font></td>
<td width="34%"><small>$</small></td>
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<td width="64%"> </td>
<td width="7%"><small>$20.00</small></td>
<td width="22%"><font size="1">2-Year Subscription</font></td>
<td width="34%"><small>$</small></td>
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<td width="64%"><small>Membership Self-Adhesive Mailing Labels</small></td>
<td width="7%"><small>$60.00</small></td>
<td width="22%"> </td>
<td width="34%"><small>$</small></td>
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<td width="64%"><small>Membership Diskette</small></td>
<td width="7%"><small>$40.00</small></td>
<td width="22%"> </td>
<td width="34%"><small>$</small></td>
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<td width="64%"> </td>
<td width="7%"> </td>
<td width="22%"><b><small>SUBTOTAL</small></b></td>
<td width="34%"><small><b>$</b></small></td>
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<b><i><font size="1">
<p>HACU Members receive a 10% discount. Shipping & handling charges not included.</font><u></p>
<p><small>SHIPPING & HANDLING CHARGES</small></i></b></p>
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<td width="16%"><small>Number of items</small></td>
<td width="11%" align="center"><small>1</small></td>
<td width="13%" align="center"><small>2-3</small></td>
<td width="14%" align="center"><small>4-5</small></td>
<td width="17%" align="center"><small>6 or more</small></td>
<td width="29%"> </td>
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<td width="16%"><small>S&H Charges</small></td>
<td width="11%" align="center"></u><small>$2.00</small></td>
<td width="12%" align="center"><small>$3.00</small></td>
<td width="14%" align="center"><small>$5.00</small></td>
<td width="17%" align="center"><small>$8.00</small></td>
<td width="29%"><small>$</small></td>
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<td width="16%"> </td>
<td width="11%" align="center"> </td>
<td width="13%" align="center"> </td>
<td width="14%" align="center"> </td>
<td width="17%" align="center"><small><b>S&H</b></small></td>
<td width="29%"><small>$</small></td>
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<p><small>TAX EXEMPT #_______________(please enclose certificate) </small></p>
<p><small>
Sales Tax if applicable* $________</small></p>
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<p><small>*(TEXAS AND DISTRICT OF COLUMBIA RESIDENTS ONLY)</small></b></p>
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<p><small>THANK YOU!! Payment in US Dollars ORDER TOTAL
$________</small></b></p>
<p><small><u><em><strong>PAYMENT METHOD</strong></em> </u> CASH______
CHECK______ <small>(make check payable to HACU - $25 fee for returned
check)</small> </small></p>
<p><small>CREDIT CARD: VISA______ MASTERCARD______
AMEX_______</small></p>
<p><small>ACCOUNT# ________________________________________________ Expiration
date: ___________</small></p>
<p><small>Name as it appears on card: _____________________________________(please print)</small></p>
<p><small>Signature: __________________________________________________</small></p>
<p> </p>
<p><u><i><b><small>SHIPPING INFORMATION (please print)</small></b></i></u></p>
<p><small>NAME:_______________________________________________
TITLE:_________________________</small></p>
<p><small>AGENCY:_____________________________________________</small></p>
<p><small>ADDRESS:____________________________________________</small></p>
<p><small>CITY/STATE/ZIP
CODE:_________________________________________________________________</small></p>
<p><small>PHONE#: (_______)___________________________ FAX#:
(_______)________________________</small></p>
<p><small>PLEASE ALLOW 4-6 WEEKS FOR DELIVERY</small></p>
<p><small> *8415 <a NAME="QuickMark"></a>Datapoint Dr., Ste. 400 *San Antonio, TX
78229 *Phone: (210) 692-3805 *Fax: (210) 692-0823</small></p>
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