Step 1: To Order "Soul Proof"
or "The Best of Sou-utions" by fax or mail, print
this form now.
Step 2: Fill out the form that you printed.
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Step 3:
Mail or Fax this completed form and your check, money order in
US funds or credit card information to:
Dr. Mark Pitstick
42 N. Plaza Blvd.
Chillicothe, OH 45601
Fax: 740-774-4478
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Purchaser
Information
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Please
Print *Full
Name:
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Company:
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*Day
Phone:
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Home
Phone:
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*Email:
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*Retype
Email
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*Address1:
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Address2:
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*City:
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State
/Province/
County
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*Postal/Zip
Code:
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*Country:
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Ship
To Information
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Please
leave blank if same as billing address.
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Ship
To Name:
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Ship
To Address1:
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Address2:
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City:
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State
/Province/
County
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Postal/Zip
Code:
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Country:
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Product
Order Information
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Quantity
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Description
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Total
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Soul Proof Book (USA)
shipped within USA $24.95 ea
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Soul Proof Book (International)
shipped outside USA $29.95 ea
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Best of "Soul-utions"
audio tapes (USA) shipped within USA $24
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Best of "Soul-utions" audio
tapes (International) shipped outside USA $29 |
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Payment Method
(Circle One): |
Check
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Money
Order
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VISA
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MasterCard
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Discover
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| Credit Card #: |
_______________________________ |
Expires:
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___/20___
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| Name
(Print):_________________________________Signature:____________________ |
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Address: ________________________________________________________________ |
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City: _______________________________ |
State:
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________ZIP:
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_____________ |
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Telephone #: ________________________ |
E-Mail:
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_______________________ |
Total
sent by check, money order or credit card $_____________________
( All prices include Tax
and Shipping)
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