Living With Fibromyalgia

Living With Fibromyalgia
ORDER FORM

– Please print out and complete this form to place your order –
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Bulk orders, please do NOT use this form.
Contact us for special pricing and shipping information.
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______ Copies of DVD

______ Exhibition DVD

x $29.95

x $149.95

= $ ____________


SUBTOTAL		= $ ____________


Applicable Sales Tax California residents add 8.5%				= $ ____________


$1 Unit Shipping & Handling		x $5.95		= $ ____________

$________ Additional Units S & H

x $1.50
each

= $ ____________


$


GRAND TOTAL		= $ ____________

SHIP ORDER TO:
(please print in block letters)

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First Name

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Last Name

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Company or Organization

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Street

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Apartment or Suite Number

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City

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State

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Zip Code / Postal Code

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Country

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Phone Number

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Email Address

MAIL ORDER FORM ALONG WITH
CHECK OR MONEY ORDER
MADE OUT TO:

Stephen Eyer Productions
1537 Lake St.
San Francisco, CA 94118

– Orders will be shipped in 5-7 business days once payment is received. –
– $25 Returned Check Fee –

Questions?
Phone: 800-724-9948
Email: stephen@stepheneyer.com