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Federal Quota Online Ordering Designation Form

Assistant's signature:__________________________________________

Ex Officio Trustee's Signature: __________________________________________

Return completed form to:

American Printing House for the Blind
Attn Cindy Amback
1839 Frankfort Ave
Louisville KY 40206

Assistant accounts for ordering online with Federal Quota funds will be finalized upon receipt of a completed designation form signed and dated by the current Ex Officio Trustee on the above listed account. Questions should be directed to Cindy at 800-223-1839, ext. 257