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:
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    NAME OF TAPE  OR CD                     QUANTITY             ITEM PRICE       
______________________________________________________________
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                                                                                    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