Parchment Frame Order Form

Full Name:

Address:

City:

Province/State:

Postal/Zip Code:

Phone Number:

Email Address:

Order Information

Qty	Item	Price	Total
0 1 2 3 4 5	Diplomat Parchment Frame (double suede mat)	$105.00
0 1 2 3 4 5	Briarwood Parchment Frame (double mat)	$95.00
0 1 2 3 4 5	Ravine Parchment Frame (double mat)	$100.00
0 1 2 3 4 5	Contemporary Parchment Frame (double mat)	$60.00
0 1 2 3 4 5	Pewter Photo Frame with AU Coat of Arms (double mat)	$30.00
Shipping:
Order Total:

Payment Information

Prices include applicable taxes.

Payment Method:

Visa
Mastercard
Cheque (make payable to: Athabasca University)

Credit Card Number:  ____________________________   Exp. Date: 123456789101112/2013201420152016201720182019202020212022202320242025202620272028
Name of card holder:
Signature of card holder: ____________________________

Please send the cheque and a copy of this form to:
Athabasca University Alumni Relations
#1200 10011 109 Street
Edmonton, Alberta Canada T5J 3S8

How to Place an Order

Please fill out this form, print it and fill in your creditcard number and fax it to: 780-421-5850 or mail it to: Athabasca University Alumni Relations
#1200 10011 109 Street
Edmonton, Alberta Canada T5J 3S8

Questions? Please call 800-788-9041, extension 7285 or email austore@athabascau.ca

Privacy Policy

The personal information collected is needed for processing your order. It is collected under authority of Section 33(c) of Alberta’s Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information, please contact Alumni Relations.