Iceland Book Club Online Order Form 


For Iceland Book Club Members Only, but you can join for FREE!  Just fill this out and Mark New Club Member.

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please provide your account information:

First Name
Last Name
Password
Confirm Password

Shipping and Handling Charges

$00.00 to $19.99….$4.75
$20.00 to $34.99….$5.75
$35.00 to $39.99….$6.95
$40.00 to $59.99….$8.99

$60.00 to $79.99….$9.95
$80.00 to $124.99…$10.95
$125.00 and up……$12.95

 

Please provide the following ordering information:

QTY DESCRIPTION

BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Select any of the following options that apply:

Book Club Member
New Book Club Member


 
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Revised: May 24, 2004