ORDER FORM. PLEASE PRINT AND MAIL TO ADDRESS BELOW
NAME: _________________________________
SHIP TO ADDRESS
________________________________________________________
DAYTIME PHONE NUMBER: ____________________________
EVENING PHONE NUMBER: ___________________________
EMAIL ADDRESS: _____________________________________
EACH GAME IS $40 PLUS $10 SHIPPING AND HANDLING
QUANTITY ORDERED: ______________________
������� �������������������X������������������� $50
COUPON CODE FOR DISCOUNT: __________
                                     
DISCOUNT $______
TOTAL DUE AFTER DISCOUNT: _______________________________________
HOW DID YOU HEAR ABOUT MINDFIELD TRIVIA? (PLEASE COMPLETE SO I CAN DONATE A PORTION TO THE CORRECT ORGANIZATION)  ________________________
ARE YOU PART OF AN ORGANIZATION INTERESTED IN USING MINDFIELD AS A FUNDRAISER? __________________________
IF YES, NAME OF ORGANIZATION AND CONTACT PERSON:___________________
PLEASE PRINT THIS PAGE AND MAIL WITH CHECK OR MONEY ORDER TO:
THWAPRS COMPANY
P. O. BOX 1191
ROSLYN, PA 19001
QUESTIONS? CALL 1-866-490-5550
THANK YOU!!
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