Purpose:
This
form enables users to make payment
to the Center for photo reproductions
and other fees, etc., by using a credit card
(in person; by letter to Center of Southwest
Studies, Fort Lewis College, 1000
Rim Drive, Durango, CO 81301-3999; by phone to
970-247-7456; or by fax to
970-247-7422 -- but not by email, due to security considerations).
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Date: |
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Address (street
or p.o. box): |
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City, State, and
Zip Code: |
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Country (if not
U.S.) |
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Description of sale: |
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Type of credit
card: |
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Mastercard VISA
Discover |
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Credit card
number: |
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Credit card expiration date:________ |
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Amount of
charge: |
US$ |
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SW-93
Page last modified: August 09, 2007
