Order Form



                  GRIEFNET ORDER FORM
                  FOR TEEN MOMS ONLY




Bill to:_______________________________________

Organization:_____________________________________

Address_____________________________________

       _____________________________________

City_________________________________________

State__________________Zip+4______/_______

Attention:__________________________________


Ship to:_______________________________________

Organization:_____________________________________

Address_____________________________________

       _____________________________________

City_________________________________________

State__________________Zip+4______/_______

Attention:__________________________________


After the Loss of Your Baby: For Teen Mothers - English Version    Code ATLE
After the Loss of Your Baby: For Teen Mothers - Spanish Version    Code ATLS

Quantity    Unit Cost       Shipping and Handling Charges

1             $3.50           1 copy   $1.75
2 - 10        $3.00           Add $ 0.20 for each additional copy
11 - 100      $2.75
101-500       $2.50
(Call for larger quantities)

_________________________________________________________________________________
Code       Unit Cost     No. ordered     Total     1-2 books will be mailed 1st class.
                                                   Other orders will be sent book rate.

_________________________________________________

_________________________________________________

IL residents add 6 1/2% sales tax.
Shipping and Handling
UPS 2 day ground shipping add $2.00
Canada orders add $2.00
Total enclosed:____________________________________

Send check of money order in US funds to:
     For Teen Moms Only
       P.O.Box 962
      Frankfort, IL 60423              Phone: (815)-464-5465

Institutions may mail or phone in purchase orders. Please mention GriefNet in your order.

Please allow 2 - 4 weeks for delivery. 

Return to For Teen Moms Page