Date: ______________________________________________

Name: ______________________________________________

Institution: _____________________________________________________________________

Address: _________________________________________________________________________
         
         _________________________________________________________________________ 
 
         _________________________________________________________________________

City/State/Zip Code: _____________________________________________________________

Country: _________________________________________________________________________

Phone: _________________________           Fax: __________________________________ 

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Series and|                                          |            |
Number    |                   Title                  |  Quantity  |    Amount
__________|__________________________________________|____________|_______________                
                                                        
          |                                          |            |
__________|__________________________________________|____________|_______________
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                                                     |            | 
[AGENCY USE ONLY: 88-60-9010]                TOTAL   |            |   
_____________________________________________________|____________|_______________
                               
IF THERE IS A COST FOR THE REQUESTED      FOR FREE ITEMS ONLY, SEND FORM TO:
ITEM, PLEASE INDICATE FORM OF PAYMENT,
AND SEND FORM AND PAYMENT TO:             Information and Research Services
                                          International Programs Center
U.S. Department of Commerce               Bureau of the Census
Bureau of the Census                      Washington, D.C.  20233-8860
P.O. Box 277943                              
Atlanta, GA 30384-7943                    fax:   (301) 457-2643         

[ ]  Enclosed is a check or money         email: pop@census.gov            
     order payable to                     
     "Commerce/Census"                    
                                          
[ ]  Charge to Census Bureau              
     Account No. 9_ _ _ .
                                          
[ ]  Credit Card                          SORRY, PURCHASE ORDERS CANNOT BE ACCEPTED
                                          
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