ORDER FORM
— PLEASE PRINT THIS FORM —
Fill in the information below, enclose a check or money order for the total amount made payable to Catherine Kemper, and mail to the address at the bottom of this form. No puzzle will be constructed until checks have cleared. Be sure to include a copy of your publication and/or your complete web site address with your order form—no orders will be accepted without it!
| PUZZLE TYPE | MEDIUM
(Newspaper, Web Site, or Other [please specify]) |
PUZZLE SIZE
(including sponsor signature) |
PRICE PER PUZZLE |
NUMBER OF PUZZLES | SPONSOR SIG DESIGN FEE* | TOTAL PRICE |
| Cryptogram | $10.00 | $5.00 | $ | |||
| Solve-A-Quote | $30.00 | $5.00 | $ | |||
| Word Search #1 | $20.00 | $5.00 | $ | |||
| Word Search #2 | $30.00 | $5.00 | $ | |||
| Logic Puzzle | $100.00 | $5.00 | $ | |||
| Other Puzzle (please specify) |
(As Quoted) | $5.00 | $ | |||
| If puzzles are to be mailed other than via USPS, please add charges for each puzzle | $ | |||||
| FINAL TOTAL | $ | |||||
Publication/Web Site Name: ___________________________________________________________ Mailing Address: ___________________________________________________________________ City / State / Zip: ___________________________________________________________________ Web Site Address: ____________________________ E-mail Address: _________________________ Contact Name: ________________________________ Phone No.:____________________________ |
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| Method of Payment (circle one): cashier's check / personal check / business check / money order | ||||||
| Puzzle Frequency (circle one): weekly / biweekly / monthly / bimonthly / quarterly / one time only | ||||||
| Deadline Date(s): | ||||||
| Who will supply material for puzzles (ie, quotes, clues)? (circle one): Contact person / Puzzles by Cathy | ||||||
| Sponsor Name: (please enclose sponsor info and logo to be scanned or web site from which to download logo) * If multiple sponsor signatures need to be designed, please add $5.00 for each sponsor. |
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| Where puzzles will be mailed to (if different from above): Address: _________________________________________________________________________ City / State / Zip: ___________________________________________________________________ |
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