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Order Form
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Ordering over the internet using a VISA® or MasterCard® credit card is just as safe as making a purchase at your local store or restaurant. However, if want to place an order using standard mail, you can do so with this form. Just print this page, fill it out, and mail it to us with payment. |
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Name:
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___________________________________________ | ||||
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Street
Address
or P.0. Box: |
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City:
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___________________________________________ | ||||
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State:
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_________ Zip Code: _________________________ | ||||
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Telephone:
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(________) _______________________ | ||||
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E-mail:
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___________________________________________ |
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Quantity
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Item
No.
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Description
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Unit
Price
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Total
Order:
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California
Residents Only add 7.75% Sales Tax:
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Shipping
& Handling (Click here for rate chart):
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Grand
Total:
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Add $5.00 for COD |
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Make your check or money order payable to: LifeSkills |
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Mail To: |
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E-mail comments to: lrsc@rpeurifoy.com Disclaimer: This site contains general reference information and is not intended as a substitute for consulting with a physician or a psychotherapist. Copyright © 1999 by Reneau Peurifoy, MA — All Rights Reserved |