47
THE CAPITOL DOME
SUB-TOTAL:
TAX:___________________________
TOTAL:
_____________________________
NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
EMAIL: PHONE:
YOUR INFORMATION
METHOD OF PAYMENT
You may fax this form to
(202) 525-2790 or mail to: USCHS,
200 Maryland Ave., NE, Washington, DC 20002-5796
Questions?
Call toll-free: (800) 887-9318 ext. 10
For local calls: (202) 543-8919 ext. 10
SHIPPING AND HANDLING
$20
00
or less $7.95 $50
01
to $75
00
$18.95
$20
01
to $30
00
$9.95 $75
01
to $100
00
$24.95
$30
01
to $40
00
$12.95 MORE THAN $100
00
$34.95
$40
01
to $50
00
$14.95
PLEASE ADD $25.00 SHIPPING FOR EACH FRAMED PRINT.
FOR PACKAGES OVER 25 LBS., ADD $10.00 PER 10 LBS.
ITEM NUMBER QUANTITY UNIT PRICE EXTENDED
PRICE
DOME MARKETPLACE
*MD Tax (6.0%) & DOC Tax (5.75%)
Enclosed is a Check or Money Order payable to U.S. Capitol Historical Society
I am paying by Credit Card (please circle one):
VISA MC AMEX DISCOVER
CARD # _________________________________ Exp. date:___/___/____
Code: _______ /______
Cardholder Signature
(required): ___________________________________
Leaving a Legacy
By including USCHS in your bequests, you can instill and foster informed citizenship for generations to come.
If you are considering a bequest to USCHS, here is some suggested wording for your attorney:
After fulfilling all other specific provisions, I give, devise, bequeath _____% of the remainder
[or $_____] to the United States Capitol Historical Society, a District of Columbia charitable corporation
[Tax ID #52-0796820] currently having offices at 200 Maryland Ave., NE, Washington, DC 20002.
For more information please contact Laura McCulty Stepp, VP, Membership and Development at 202-543-8919 x22.
MARKETPLACE ORDER FORM