ORDER FORM

Park Press Publishers

Division of Park Avenue Printers Inc.

372 Lovell Street

Worcester, MA 01602-3312

Phone (508) 756-8600 – Toll Free (877) 856-8600 Fax (508) 754-9714

Print this form. Internet ordering not available.

To order copies of WHEELCHAIR MOBILITY ~ the video, Living with Spinal Cord Injury, or Wheelchair Mobility ~ A Handbook, fill out the information requested below. All orders must be prepaid and include shipping. We accept company and individual checks (allow 15 business days for clearing and processing). For your convenience, we also accept MasterCard, Visa, American Express and Money Orders. When using a credit card, please be sure to include expiration date and Signature for validation.

---

Shipping Address

Name___________________________________________________________________

Address_________________________________________________________________

City____________________________________________________________________

Phone___________________ Fax_______________ email_________________________

Dept. or Attention_______________________ Check or Money Order No.____________

---

---