NYC-WTC_000174805

NYC 9/11 Public Portal Document

AMERICAN REGISTRY OF PAT»«^i«^GV

AFIP Fascicles & C refer Form Type or print clearly. For faster delivery, do not use P.O. boxes. T I MAIL OR FAX ENTIRE PAGE TO: I Company or personal name I American Registry of Pathology Bookstore I I AFIP — Room1077 I Additicncl address/attention line I Washington, DC 20306-6000 I I Phone:202-782-2666 FAX: 202-782-0941 I Stree'. address I Toll-freephone: 1-888-838-1297 (U.S A. only) I I Toll-free FAX: 1-800-278-8513 (U.SA. only) I J NEW SUBSCRIBERS: City, state, ZIP code or coiiptry O I wish to become a new AFIP ATLAS Subscriber □ Fascicles □ CD-ROMs CJ Both Business phone FAX New Subscribers—credit card & phone numbers required. E-mai, TERMS AND CONDITIONS: The American Registry of Pathology is authorized to send me the items ordered and one copy of each future AFIP Atlas of Tumor Pathology (Series III), CD- Please Choose Method of Payment ROM, or both as indicated above, at a 20% discount (35% for residents and fellows) plus shipping and handling for future O Check or money order payable to American Registry of Pathology publications ($4,00 per item within U.S.A., 25% outside continental enclosed. (U.S. dollars only) U.S.A) The books or CD-ROMs will immediately be charged to my credit card number and mailed to the address shown below. I understand that I have 14 days in which to return unwanted items 123 Charge my MasterCard, Visa, AMEX, or Eurocard Account Number

n to the American Registry of Pathology, with subsequent credit to my account.’ I also understand that I may withdraw, with written notice, from the AFIP ATLAS SUBSCRIBERS PROGRAM or the ELECTRONIC FASCICLE SUBSCRIBERS PROGRAM at any time. Residents and fellows must send a letter from Training Director showing Exp. Date__ _ Signature___ status. Prices subject to change. •NOTE; CD’S can only be returned if unopened or if received damaged.

Book and CD-ROM sales arc not for consignment. We reserve the right to Signature Date correct any calculation or clerical errors before charging your credit card.

ITEM# TITLE UNIT PRICE TOTAL

i______ mSCOWNTS NL10O1 Gross Price—SUBTOTAL----- SUBSCRIBERS: (AAS# .) (EFS# .) □ 20% or 35% discount—I am an AFIP Subscriber % of Discount—see at left SHIPPING & HANDLING___ NON-SUBSCRIBERS: $4.00 per copy - OR add 6% of SUBTOTAL above O 10% discount—I am a FASA member (# .) over five copies if shipped within continental U.S. O 25% discount—I am a Resident or Fellow All other orders add 25% of SUBTOTAL Supply Training Director’s name TOTAL COST OF BOOK ORDER-----

CITY_21MC100_012564837

NYC-WTC_000174823