Iberian Publishing Co. - 548 Cedar Creek Drive - Athens, GA 30605-3408
| Customer's Name | Ship To Name (if different) | |||||||
| Address | Address | |||||||
| City | State | Zip | City | State | Zip | |||
| Quantity | Name of Item | Price | ||||||
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To process a credit card we MUST have your name as it appears on the card | Total price of items | . | ||||||
| Shipping/Handling (retail orders)
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| Residents of Georgia please add7% sales tax | . | |||||||
| Total Enclosed (U.S. Funds Only) | . | |||||||
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| CREDIT CARD # | Expiration Date | 3-digit security # on back | ||||||
| Signature | Telephone Number | E-mail address (optional) | ||||||