June 14, 2019 Jared Shih Test PayPal Payments $10 Shipping & Handling Brochure - Test does not allow you to purchase more than 200 brochures Name* First Last Org/Co Name Email* PhoneAddress* St. Address or PO Box City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code No out of country mailingsPurpose for handouts Date Brochures Needed By Comments only text no punctuationPlease choose the quantity of each handout type that you ordered using the drop downs below. Any combination of free handouts can be ordered in quantities from one (1) to 200 maximum order. Sorry we cannot honor larger orders. For Example: 100 LymeR PrimerTM & 100 The ABC’s of Lyme DiseaseTM = 200 brochures OR 75 LymeR PrimerTM , 75 The ABC's of Lyme DiseaseTM & 50 TickcardsTM = 200 brochuresNumber of Tick CardsPlease enter a number from 0 to 200.Number of ABC'sPlease enter a number from 0 to 200.Number of LymeRPrimer'sPlease enter a number from 0 to 200.Total BrochuresMaximum number of brochures allowed is 200.Total Shipping and Handling Price: Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Δ