ORDER FORM

Please print and fill out this form, enclose payment, and mail to:

RIVER VALLEY CHILD DEVELOPMENT SERVICES
611 SEVENTH AVENUE, SUITE 208
HUNTINGTON, WV 25701
PHONE: 304-523-0433 OR 1-866-982-2237
FAX: 304-697-6613

Ordered By:

Address:

Daytime Phone:

Ship to (if different from "ordered by")

Name:

Address:

Payment Enclosed:

Purchase Order Enclosed:

**Please make check payable to: River Valley Child Development Services
Purchase orders are accepted from the organization.

Thank you for your order!

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