Keene Publishing Order Form

    If you would like to fax or mail us an order, please print and fill out this form. Make your check payable to Keene Publishing or complete the credit card payment area. Orders cannot be processed until payment is received. Please print clearly!

    Fax the completed form to:  (845) 987-7845 or mail to:

Keene Publishing
PO Box 54
Warwick, NY 10990-0054

    Date_______          Bill To

    		Ship To
    Name  Name  
    Company  Company  
    Address  Address  
    City, State  City, State  
    Zipcode  Zipcode  
    Country  Country  
    Phone #  Phone #  
    Email  Email  
    CC Type  

    Exp.(MM/YY)

    		  
    CC #  

    Security Code*

    		  
    Print Name  

    Signature

    		  
    Special
    Instructions     		 
    ISBNTitleQtyPrice Total (Qty x Price)
    976680505 Days Gone By  
    29.00
    		  
         
         
         
    Shipping & handling ($4 per book)
    		 

    Subtotal

    		$

    NY and PA residents add Sales Tax for your county (ex. Orange Cty. 8.125%; York Cty. 6%)

    		$

    Total Due

    		$

    *What is the Security Code? - You will find this important new security feature on the back of most Visa and MasterCards, and on the front of American Express cards.  The security code helps validate that the customer placing the order actually has the credit card in his/her possession. It is a 3 or 4 digit number.