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Graphis - G2002 E 0 (Page 11)

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Graphis - G2002 E 0
Check one only--please submit a separate payment form for each book.
s D e s i g n Annual 2003 s A d v e r t i s i n g Annual 2003 s P romotions 2
s P h o t o A n n u al 2003 s Annual Reports 8
s Under 30 2003 s P roduct Design 3 s Book Design 3 s Poster Annual 2003
Title of Entry
C o d e #/Category
To t a l s
1
2
3
4
5
6
7
8
9
1 0
Subtotal Entry Fees
Book Title
Re gular Pr i c e
Q u a n t i t y
Advertising Annual 2002
$70.00
$56.00 x
=
Design Annual 2002
$70.00
$56.00 x
=
P romotions 2
$70.00
$56.00 x
=
Photo Annual 2003
$70.00
$56.00 x
=
Annual Reports 8
$70.00
$56.00 x
=
Under 30 2003
$70.00
$56.00 x
=
P roduct Design 3
$70.00
$56.00 x
=
Book Design 3
$70.00
$56.00 x
=
Poster Annual 2003
$ 7 0 . 0 0
$56.00 x
=
Shipping and Handling per book
USA or Europe
$ 1 0
International
$ 2 5
=
NY Residents add 8.25% tax to book order
Subtotal books
Total Entry Fees and Books
s Check (US$, Drawn on US Bank Only) s Int'l. Money Order (US$)
Credit Card: s Visa s MC s AMEX (Charged in US$) s BANK TRANSFER
Card #
Exp. Date:
Cardholder's Name:
Cardholder's Signature:
$
$
Sender's Name
Title
Company
Key Code
Address
City
State
Zip/Postal Code
Country
Phone
Fax
E-mail
In submitting work for consideration, I have read and agree to all Terms
& Conditions listed herein and on the reverse side of this form. In partic-
u l a r, I warrant that I have the rights to use all images contained in my
submission and agree to indemnify Graphis Inc. against any claim which
may arise from my submission.
Attach Entry Labels Here
OrderNow &Save 2 0%
Permission & License
Signature Required
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Payment Form
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S I G N AT U R E :
D AT E :
Note: Entries without signatures will not be considered.
Total
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