newbanner.GIF (4689 bytes) Museum Store Order Form

Print this form and send to:
State Historical Society of North Dakota
612 East Boulevard Avenue
Bismarck, ND 58505-0830
Telephone (701) 328-2666        FAX (701) 328-3710

Bill to:

Ship to (if different from "Bill to" information:
Name Name
Address Address
City/State/Zip  City/State/Zip 
Telephone Telephone

Qty

Description

Price Each

Total
       
       
       
       

Shipping and Handling
Standard Delivery (USA)
Merchandise Total S&H
Up to $15.00 -             $ 4.95
$15.01 to $25.00 -       $ 6.95
$25.01 to $50.00 -       $ 8.95
$50.01 to $75.00 -       $10.95
$75.01 to $100.00 -     $12.95
$100.01 to $200.00 -   $14.95
Over $200.00 -            $16.95

Subtotal $___________

Members Discount 15% $___________

Shipping/handling $___________

ND residents add 5%,                           
Bismarck residents add 6% sales tax $___________

Total enclosed (U.S. Funds) $___________

International orders please call for shipping rates

Please enclose payment with your order. Make checks payable to: State Historical Society of North Dakota. Payment method:   ____check enclosed ____credit card: _____Visa _____Mastercard

Card#_______________________ Expiration Date ________________

Signature____________________________