| Please print this form, fill it out and fax it to:
+44 1428 607 571
From the US and Canada, dial 011-44-1428-607-571
From all other countries, dial your international access code and then 44-1428-607-571
Trailblazer Books by Fax Order Form
Title of the Book You Are Ordering:
_________________________________________________________
Your Name: Mr Mrs Ms Dr _____________________________
Your Fax Number (with country Code) _______________________________________
Your Mailing Address:_______________________________________
City:_______________________________________
State or Region_______________________________________
Postal (Zip) Code_______________________________________
Country_______________________________________
Credit Card Type (circle one):
Visa | MasterCard/Euro Card | Switch | JCB
Credit Card Number _______________________________________
Expiry Date:_______________________________________
Name as printed on the card_______________________________________
Cost of the Book________________
Shipping: INCLUDED IN PURCHASE PRICE - NO EXTRA CHARGE
Total _________________
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