ARC ORDER FORM
Abstinence Resource Centre					Phone: 937-223-5250
One Elizabeth Place					Fax: 937-461-3702
Dayton, OH 45408					E-Mail: order@abstinence.biz
					www.getthetruth.net
Billing	Information						Date:
Name
Agency
Mailing	Address
E-mail	Address
Phone#
Shipping	Info if Different
Qty	Item Code		Item Description				Unit Price		Total
							Subtotal
			Shipping/Handling 10% of order ($5.00 minimum):
			OH Residents add 7% tax or include tax exempt#
						Total:	TOTAL:
Special Information (i.e. need-by date):
Enclosed is my:
[    ]	Credit Card Number:
		Type:
		Name on Card:
		Expiration Date:
[   ] Check    [  ] Money Order  [   ] Purchase Order:
*Shipping and handling is $5.00 for orders under $50.00 or 10% of orders over $50.00
*Please allow 4-6 weeks for delivery. Additional charges may apply for rush orders.
*We reserve the right to change pricing as necessary.
	The Abstinence Resource Centre is part of a non-profit organizations. Proceeds from Item sales go toward continuing our efforts to promote and support the healthiest choices for youth, families and communities.