| ORDER FORM |
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| NO. OF |
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CHECK ONE |
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| ITEMS |
DESCRIPTION |
BOOK |
VIDEO |
AUDIO |
OTHER |
PRICE |
TOTAL |
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How to Recognize Substance Abuse |
X |
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14.95 |
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The YOU In Business |
X |
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15.95 |
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Life Rage |
X |
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19.95 |
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| Shipping &
Handling Charges |
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1 item: |
$3.00 |
SUBTOTAL |
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2-5 items: |
$4.75 |
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6-10 items: |
$7.25 |
OH
Residents add 6.25% sales tax |
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11-25 items: |
$10.75 |
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Over 26
items, call for price discount. |
Shipping & Handling (see chart) |
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TOTAL |
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| PAYMENT METHOD: |
_____Check
Enclosed _____Master Card _____Visa |
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| Expiration
Date: |
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| CCV2 |
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card) |
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| Name card is in |
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| Address from
statement |
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STREET |
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CITY |
STATE |
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ZIP |
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| Office use
only: |
Date Received:____________ |
Date Shipped:____________ |
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