Order Form

Prices current through December 30, 2009.

To order Institute products, please print this form and send with a check or a purchase order payable to University of Minnesota (tax ID # 416007513) at: Publications Office, Institute on Community Integration, University of Minnesota, 109 Pattee Hall, 150 Pillsbury Dr. SE, Minneapolis, MN 55455. Orders for free items may be phoned to (612) 624-4512 or faxed to (612) 624-9344. Orders cannot be taken electronically. Note: This form may print in two pages.

Publication (please print or type title fully):	Price per copy	Quantity	Total price
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Publications Total	$ __________
Sales Tax (Minnesota only. Does not apply if tax-exempt. See note below for rates*)	$ __________
TOTAL	$ __________

Purchase Order/Check Number: _____________________________

Orders must be accompanied by purchase order or check payable to University of Minnesota (tax ID # 416007513). We reserve the right to limit quantities on complimentary items. Prices include shipping within the U.S. (by Media Mail); for information on other shipping options and costs, contact the Publications Office. Tax-exempt Minnesota organizations: Please provide copy of exemption certificate if first time ordering.

Name ________________________________ Phone ____________________

Agency _________________________________________________________

Address _________________________________________________________

City ________________________________ State _______ Zip _____________

*Minnesota Sales Tax Rates:

Minneapolis = 7.775%. Hennepin County outside Minneapolis = 7.275%.

St. Paul = 7.625%. Ramsey County outside St. Paul, as well as Anoka County, Dakota County, Washington County = 7.125%.

Albert Lea, Austin, Baxter, Bemidji, Brainerd, Clearwater, Hermantown, Mankato, New Ulm, North Mankato, Owatonna, Proctor, Rochester, St. Augusta, St. Cloud, St. Joseph, Sartell, Sauk Rapids, Two Harbors, Waite Park, Willmar, Worthington = 7. 375%.

Duluth = 7.875%. Elsewhere in Minnesota = 6.875%.

End of Order Form