Anarchist Cookbook(s) Order Form

SEND YOUR PAYMENT TO:

Discount Store
PO Box 241471
Milwaukee, WI 53224

You may also print this form and fax it to
305-946-3315

Please send me the Anarchist Cookbook(s) I have checked below, in the following format:

Anarchist 2002 CD ($22.95 Shipped)
Anarchist 2002/2000 Download ($19.95)
Anarchist 2000 Printed ($24.95 Shipped)


Your Name:

Address Line 1

Address Line 2

City

State

Zip

Email address

Phone #

Please Check One:

Check / Money Order Enclosed

Charge It On My: Visa Mastercard

Credit Card Number Card Expiration

3 Digit Credit Card Verification Number
Listed on back of card, after card account number

Name as it appears on card


Cardholder Signature

I authorize "EZ Discount Store" to charge my credit card for
the Anarchist Cookbook  for the amount as specified on my selection above 

(If ordering with credit card, this must be returned with card holders signature!)


Discount Store
PO Box 241471
Milwaukee, WI 53224
Fax: 305-946-3315