Please enter the following information (Poster price includes tax & shipping) For CREDIT card purchases, BILLING address of the card must be entered:
First Name:
Last Name:
Store Name or Company Name :
Address Line 1:
Address Line 2:
City:
State (poster will be for this entry unless specified below):
Zip Code:
Area Code & Phone Number:
E-mail Address:
KGA/KACS MEMBER Combo Federal/State Poster Pricing:	Select KGA/KACS MEMBER poster quantity 1 poster  $39.00 2 posters  $76.00 3 posters  $111.00 4 posters  $144.00 5 posters  $175.00 6 posters  $204.00 7 posters  $231.00 8 posters  $256.00 9 posters  $279.00 10 posters  $300.00 11 posters  $319.00 12 posters  $336.00 13 posters  $351.00 14 posters  $364.00 Call for larger quantity pricing
KGA/KACS NON-MEMBER Combo Federal/State Poster Pricing:	Select KGA/KACS NON-MEMBER poster quantity 1 poster  $49.00 2 posters  $96.00 3 posters  $141.00 4 posters  $184.00 5 posters  $225.00 6 posters  $264.00 7 posters  $301.00 8 posters  $336.00 9 posters  $369.00 10 posters  $400.00 11 posters  $429.00 12 posters  $456.00 13 posters  $481.00 14 posters  $504.00
Purchase Order Number:
Multi-state locations? Specify states & quantities for each:
Payment Method	Credit Card Check or Money Order