ORDER FORM |
SELF-HELP SOLUTIONS |
MAIL YOUR ORDER TO: Dr. Thomas Yarnell 185 Kenmore Ave. Biloxi, MS 39531 U. S. A. |
You may print this order form and mail it to us or just copy the appropriate information on a blank piece of paper and mail it along with a check for the correct amount or your credit card information. You can also fax your order. FAX YOUR ORDER TO: 1-228-388-9630 |
Date:____________ May we have your email address, if you have one, just in case there is a question about your order? This is not required. _______________________ |
MAIL MY TAPES TO: _______________________________ _______________________________ _______________________________ _______________________________ |
NAME OF TAPE OR CD QUANTITY ITEM PRICE ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ SUBTOTAL _____________ SHIPPING & HANDLING SHIPPING _____________ OUTSIDE THE USA $6.00 TOTAL _____________ INSIDE USA - FREE |
METHOD OF PAYMENT |
_____CHECK or _____MONEY ORDER (Worldwide) (In U. S. Funds) *** Check or Money Order must be made out to: Dr. Thomas Yarnell)*** _____VISA _____MasterCard _____American Express Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date: Month __ __ Year __ __ Security Number: The last 3 or 4 numbers on the back of your card. They are usually written in the space where you sign. Often there will be your account number or the last 4 digits of your number and then another 3 or 4 numbers. They are your security numbers and help protect you from fraud. Your card cannot be processed without this code: __________ Customer Signature: _____________________________________ |
Thank You For Your Order |
BUY 3 GET 1 FREE |
