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Mail
Order Form
Please complete
the following form and mail
it, along with a check or money order, to SRC
at
SRC,
Inc., 2425 Bowland Pkwy., Ste. 111B, Virginia Beach,
VA 23454
Please Print or Type
1.
Payment Type: Check: □
Money Order: □
2.
If this is a gift, we will enclose a card acknowledging the sender. Please
write the name of the sender, as you would like it written on the
card:
_________________________________________________________________________
3.
Name and address
where
journal is to be sent:
_________________________________________________________________________
_________________________________________________________________________
4. Please
provide a daytime phone number where you can be reached if there are questions:
(_____)_______-____________
5.
Order:
Translation
Services : # Pages x $10 =
$
_______
□
Family History Research
Package
$500.00
□
Adoption Journal ($15.00 + 3.50 Shipping & Handling):
$18.50 □
Sales Tax (for Virginia families
only)
$
.68 □
Total
Payment
Enclosed:
$_________________
Signature:
_____________________________ |