Order Form

Claire B. Rubin & Associates
Disaster Research and Consulting
P.O. Box 2208
Arlington, VA 22202
Fed. Tax No. : 54-1242755
Tel: (703) 920-7176

All orders must be prepaid: we accept checks, cash, and money orders. [We cannot take credit cards at this time.] Please make checks payable to Claire B. Rubin

In a rush? We'll send copies via FedEx using your account number.

Discount prices: For special rates on bulk orders (25 or more copies), please call or e-mail.

Unit prices shown below include regular shipping (first class mail) and handling charges.

Enclosed is my payment for the following products:

PRODUCTS:

____ 100 years of U.S. Mining Safety ( 1909-2009), Version 1 @ $10.

____ California Earthquake History (1906-2008), Version 3 @ $10.

____Terrorism Time Line chart (2001-2008), Version 7 @ $10.

____Disaster Time Line chart (1988-2008), Version 5 @$10.

____Century Time Line (1900-2005), Version 1 @ $10.

TOTAL: _______________

SEND TO:

Name: ____________________________________________________

Address: __________________________________________________

__________________________________________________________

City:______________________ State:_______ Zip Code:____________

Phone: ____________________________________________________

E-mail address: _____________________________________________

Tax Exempt ID # (if any): _____________________________________

Rev. 3/1/10