Living With Fibromyalgia
ORDER FORM
Please print out and complete this form to place your order
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Bulk orders, please do NOT use this form.
Contact us for special pricing and shipping information.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

______ 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)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
First Name

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Last Name

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Company or Organization

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Street

/___/___/___/___/___/___/___/___/___/
Apartment or Suite Number

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
City

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
State

/___/___/___/___/___/
Zip Code / Postal Code

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Country

/___/___/___/ – /___/___/___/ – /___/___/___/___/
Phone Number

_____________________________________________________
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