To contact us:
Broda O. Barnes, M.D.
Research Foundation, Inc.
P.O. Box
110098
Trumbull, CT 06611
Phone: 203-261-2101
Fax: 203-261-3017
Email:
info@BrodaBarnes.org
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Audio/CD/Video/Reprint
Order Form
Please print, complete and
return the form below to order any items on our catalog listing.
All prices are subject
to change without notice. Allow 2 weeks for delivery.
Check or Money Order, mail
to: Barnes Foundation, PO Box 110098, Trumbull, CT 06611
Credit Card Orders, mail or
fax: (203) 261-3017
Questions: (203) 261-2101
Name:_________________________________________________
Address:________________________________________________
City: __________________ State:
______
Postal Code:_____________
Country: __________________
Daytime Phone: ___________________
___ My first time contacting the Foundation
____I have contacted the Foundation before
___ Please change my address
Quantity |
Order # |
Description |
Total Cost |
Audio Cassette or CD |
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3 items or more add shipping and handling of $5.00: $_________
International/Canadian Orders add $4.50 shipping: $_________
Total Dollar Amount of Order: $__________
Payment Method:
Check/Money Order Enclosed (made
payable to Barnes Foundation) _____
Credit Card (please cirlce one)
Visa Mastercard Amex Diners JCB
Account
# _____________________________________________
Expiration Date____________
Signature __________________________
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