State Historical Society of North Dakota Museum Store Order Form

State Historical Society of North Dakota
612 East Boulevard Avenue
Bismarck, ND 58505-0830
Telephone (701) 328-2666
FAX (701) 328-3710

Ship to:

Name_______________________________________________

Address____________________________________________

City_______________________ State______ Zip_________

Telephone___________________________________________

QTY              DESCRIPTION               PRICE EACH      TOTAL

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Shipping and Handling                                    Subtotal $___________
Standard Delivery (USA)
Merchandise Total S&H                       Members Discount 15%  $___________
Up to $15.00 -        $ 4.95
$15.01 to $25.00 -    $ 6.95                    Merchandise Total $___________
$25.01 to $50.00 -    $ 8.95
$50.01 to $75.00 -    $10.95          Postage/handling (See chart) $___________
$75.01 to $100.00 -   $12.95      
$100.01 to $200.00 -  $14.95          Tax:    ND residents add 5%, 
Over $200.00 -        $16.95   Bismarck residents add 6% sales tax $___________
International orders please call for shipping rates
                                        Total enclosed (U.S. Funds)$___________

Please enclose payment with your order. Make checks payable to: 
     State Historical Society of North Dakota. 

Payment method:
____check enclosed    credit card: _____Visa _____Mastercard _____Discover

Card #________________________________  Expiration Date_________________

Signature______________________________