ORDER FORM [click here for Ordering & Shipping Information]

 

INFOMEDIA JUDAICA, LTD. 
19785 West 12 Mile Road, # 521 
Southfield, Michigan 48076-2584		 U.S. and Canadian Orders: 866-303-3365 
Inquiries: 248-354-6415     Fax: 248-352-2665 
E-mail: orders@imjl.com       Web:www. imjl.com

 

Quantity

Catalog No.

 Item

Unit Cost

Total Cost
         
         
         
         
         
   

Sub-total:

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Michigan Sales Tax (6%) or Provide Exempt No.:

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Shipping Charges (see "Ordering Information"):

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Total Amount Enclosed, or Total Charge Authorized:

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PURCHASER

RECIPIENT (If Different)
NAME: NAME:
ORGANIZATION: ATTENTION:
STREET: STREET:
CITY: CITY:
STATE/PROV:                                     ZIP/POSTAL CODE: STATE/PROV.:                             ZIP/POSTAL CODE:
COUNTRY: COUNTRY:
PHONE NO.:                                        FAX NO: PHONE NO.:                                    FAX NO.:
E-MAIL ADDRESS: E-MAIL ADRESS:

Please mark payment method: CHECK ENCLOSED: ______ , or

VISA: _____ MASTERCARD ______ AMEX: ______ DINERS: _______

 
 

SIGNATURE REQUIRED FOR CHARGE MAIL AND FAX ORDERS:

Card No.:                                                                                 Exp.:  Signature:

 

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