POCA Club Store Order Form

POCA Club Store Order Form
note: You must print this order form and fill it in. It is not an online form.
The POCA Club Store is for POCA Members ONLY.
FAX to (509)534-3327 or mail it to the address listed on the Ordering info page.:

Shipping information	email (optional)___________________________
Phone: (____)	Member Number (required) _________________
Name: _____________________________________
Address:
City/State/Zip

Billing information:

Name:

Address:

City/State/Zip

Credit card: Visa / Master Card (please circle one)

Credit card Number:

Expiration Date:

What you want to order:
Quantity:	Description:	Price each:	Extended Price:
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NOTE:	Rush Orders Please Call		. CALL US.

Shipping:	Subtotal:	.
Rates are calculated at the time of	Handling Fee	$ 2.00
shipping, based on weight and rates at		.
http://www.usps.gov	.	.
	Total:	.