ORDER FORM FOR

U.S. 67 (FAP 310) Final Environmental Impact Statement

May, 2002

Please follow the instructions below for ordering:

1. Use this order form only for the above document.

2. Complete:

   Company Name: ____________________________________________________

   Street Address: _____________________________________________________

   _____________________________________________________

   (P.O. Box not accepted)

   City:____________________________________ State: _____ Zip: ___________

   Attention: _______________________________

   Daytime Phone: (_______)________________

   Daytime Fax: (_______)________________

   E-mail Address: ________________________

3. Mail order form to:

          Mr. Victor A. Modeer, P.E.
          District Engineer
          Illinois Department of Transportation, District 6
          126 East Ash Street

          Springfield, Illinois  62704-4792
          Attn: William Martens

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