ORDER FORM FOR "The Patriot Act Game"  (www.gotrights.net)





Name			______________________________________________

Mailing Address	______________________________________________

City, State, Zip	______________________________________________

Country		______________________________________________



RETAIL ORDERS

One (1) game-cost $25 each plus $5 shipping & handling* =    $  30.00

Five (5) games-cost $20 each plus $10 shipping & handling* = $110.00

Ten (10) games-cost $15 each plus $20 shipping & handling* = $170.00

(Retail orders include Pennsylvania and Allegheny County Sales Taxes)




WHOLESALE ORDERS must include EIN # ___________________________


Minimum order of ten-cost $12.50 each plus $20 shipping & handling for each group of 10

Please make checks or money orders out to:    
gotrights.net

and send to:   
P.O. Box 81612, Pittsburgh, PA   15217-0412

*shipping & handling prices are for Continental US, extra costs to Canada,
Alaska, Hawaii, and for international sales