Name: _______________________________________ Student ID #: _______________________________

Phone: _________________________________________________________________________________

Mailing Address: _________________________________________________________________________

_______________________________________________________________________________________

Payment Options: (circle one)
Check
Money Order
Cash

Cost:
$5.00 per book shipped in Ohio
$10.00 anywhere else in United States

Mail this form to:
Tel-Buch
303 Carroll St.
Student Union Office 53
Akron, OH 44325-4603

If book does not arrive by November 15th, please call our office at (330)972-8442.

Office Use Only

Name: _________________________________________Phone: __________________________________

Address: _______________________________________________________________________________

_______________________________________________________________________________________

Date Sent: _____________________Staff Member: _____________________________________________