Ship to: (name)_______________________________________________ (e-mail)______________________________________________ (address)_____________________________________________ (city)____________________________(state)_____(zip)_______ I have enclosed a money order or cashier's check (personal checks require an added 10 days to clear) for the amount as calculated below: Please send ___ Authentic Indiana University 17th Street Fieldhouse / Assembly Hall Bleacher Seat(s): Seat Number Preference ________   With or Without Bolts ________ No. of Seats: _____ @ $22.50 ea. ------------------------------- _______ add 7% Indiana State Sales Tax (Indiana residents only): No. of Seats: _____ @ $1.58 ea. ------------------------------- +_______ add P/H + Shipping Charges: (total charge per shipment): 1 ea. @ $7.50, 2 ea. @ $12.00, 3 ea. @ $16.00, 4 ea. @ $19.50, 5 or more @ $22.50 -------------------------- +_______ (Shipping charges based on shipments within the contiguous 48 U.S. states only) TOTAL AMOUNT ENCLOSED -------------------------------- =_______ Print this page. Mail payment and completed order form to: