Name ___________________________________
Address____________________________________________________
City _______________________State__________
Zip Code___________
Phone # ____________________ Email ___________________
________ Posters @ $10.00 = $_________
________ Signed & Numbered Posters @ $30.00 = $_________
Sub Total = $________
6% Florida Sales Tax = $_________
Shipping & Handling = $ 5.00
Total Enclosed $___________
Send Form With Quantity & Amount of Items Desired
With your Check or Money Order written to EARTH Awareness of Brevard
or Charge Information.
Credit Card: Type __Visa ___M/C ____ AMEX ____ Discover
Card # ______________________________________________
Expiration Date _____________
I authorize EARTH Awareness of Brevard to charge the above account for
items ordered.
Authorized Signature __________________________________________
Print out, Fill out & Send To:
EARTH Awareness of Brevard
Attention: EARTH MARKET
1395 Bayshore Drive
Cocoa Beach, Fl. 32931
Allow 4 to 6 weeks for Delivery
Thank you for assisting our Youth Programs.