RESERVED ONLY FOR: Prisons and Jails - orders will be observed from the Chaplain, Librarian, or Administrator. Halfway Houses, Rehab Centers, and Rescue Missions -  orders will be observed from the Administrator. U.S. Military Bases - orders will be observed from the Chaplain.

Name:	Person responsible for ordering for the facility
Organization:
Address:	Actual street address...not a home address or a P.O. Box
City:	Orders are shipped within the U.S. only
State:	AK -- AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip:
Telephone:	Ext. Please include area code
E-mail Address:
	Both telephone # and e-mail address are REQUIRED to process e-mail orders