U.S. CENSUS BUREAU

ORDER FORM

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Use this form if you wish to place an order by mail.

Send check or credit card information to: Dept. of Commerce (MS0801), P.O. Box 277943, Atlanta, GA 30384-7943
Courier Orders (Before sending a courier order, please call the Customer Service Center at (301) 763-INFO(4636). 

      Send courier orders to FB3, Room 1587, 4700 Silver Hill Road, Suitland, MD. 20746.

If you would rather place an order by phone, please call the Customer Services Center at (301) 763-INFO(4636).

         Hours: Mon-Thu 8:30-5:30 ET, and Fri 8:30-4:30 ET.

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CUSTOMER CONTACT ADDRESS ---- please print---- CUSTOMER SHIPPING ADDRESS
If Contact address is different than Shipping, please indicate under Customer Shipping Address

_________________________________________________________________________
Company or personal name
_________________________________________________________________________
If Applicable, additional address / attention
_________________________________________________________________________
Street address
_________________________________________________________________________
City, State, Zip
_________________________________________________________________________
Daytime phone

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Product Title(s) and Price:

1.	4.
2.	5.
3.	6.

Additional charges: (Not applicable for Foreign Trade Import/Export orders)

[___] International Orders Including Canada and Mexico (Add $25 per shipment)

TOTAL COST $_____________

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METHOD OF PAYMENT

[_] Check payable to Commerce-Census  [_]  Census deposit account: #___________
[_] American Express [_] Discover [_]  VISA [_]  Master Card [_]
Credit Card Account Number:_____________________     Exp: ___/____

_______________________________/____________________________/___ ________
Name on card, Signature, and Date

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Thank You for Your Order

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