Howard University
[ ] Yes, I want to order Black Women in the Academy II Conference Merchandise:
| A. | Quantity | Item | Unit Price | Total Price |
| _________ | Tote Bag x | $20.00 = | __________ | |
| _________ | Coffee Mug x | $ 8.00 = | __________ | |
| _________ | Lapel Pin x | $ 5.00 = | __________ | |
| _________ | Key Chain x | $10.00 = | __________ | |
| _________ | Journal x | $12.00 = | __________ | |
| _________ | Poster x | $10.00 = | __________ | |
| Subtotal A = | __________ |
| B. | Quantity | Size |
Colors |
Unit Price | Total Price |
| _________ | MED (T-Shirt) | ____Cream ___Raspberry ___Lt. Blue x | $15.00 = | __________ | |
| _________ | LG (T-Shirt) | ____Cream ___Raspberry ___Lt. Blue x | $15.00 = | __________ | |
| _________ | XLG (T-Shirt) | ____Cream ___Raspberry ___Lt. Blue x | $15.00 = | __________ | |
| _________ | XXLG (T-Shirt) | ____Cream ___Raspberry ___Lt. Blue x | $15.00 = | __________ | |
| Subtotal B = | __________ |
| C. | Quantity | Special Packages | Unit Price | Total Price | |
| _________ | _____ All 7 items (specify T-Shirt size & color) x | $70.00 = | __________ | ||
| _________ | _____ Tote Bag & Key Chain x | $25.00 = | __________ | ||
| _________ | _____ Tote Bag & T-Shirt (specify size & color) x | $30.00 = | __________ | ||
| _________ | _____ Journal & T-Shirt (specify size & color) x | $20.00 = | __________ | ||
| _________ | _____ Journal & Coffee Mug x | $17.00 = | __________ | ||
| _________ | _____ Poster & T-Shirt (specify size & color) x | $20.00 = | __________ | ||
| Subtotal C = | __________ | ||||
| Mailing
Information (Please PRINT),
___________________________________________________ ___________________________________________________ ___________________________________________________ Phone: (____)______-________ (daytime) (____)______-________(evening) E-Mail or Fax________________________________________ |
Total Price items | Subtotal A: | __________ | ||
| Subtotal B: | __________ | ||||
| Subtotal C: | __________ | ||||
| Subtotal A+B+C: | __________ | ||||
| Discount(Subtract10%)" | __________ | ||||
| Total Amount Due: | __________ | ||||
Method of Payment
[ ] Check [ ] Money Order (Payable in US dollars) - Made payable to:
HU/Black Women in the Academy II[ ] Credit Card [ ] Master Card [ ] VISA [ ] American Express Account #: ____________________________
Expiration Date: ________________ Cardholder Name (please print) _____________________________________
Cardholder Signature: ____________________________________________ (required for credit card transaction)
Please return completed order form with payment to :
Howard University
African American Women’s Institute
P.O. Box 590492
Washington, DC 20059
Please allow 2 to 3 weeks for delivery of merchandise