ShrinkinaBox.com Mail Order Form

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Date: _________________________  
First Name: ____________________ Last Name: _______________________
or Company Name:_____________________________________________________
Shipping Address: _____________________________________________________
City: __________________________ State/Prov.: ______________________
Zip/Postal Code: _________________ E-Mail: ___________________________
Daytime Phone: (____)_____________ Evening Phone: (____)______________

 

Payment Details

 

Quantity

Ordered

Choose The Item(s) You Wish To Order

Price

(USD)

  'Secrets of Dealing with Difficult People' ebook ($27.97) $
  'Secrets of Dealing with Difficult People' softcover book with shipping to Canada & U.S. ($39.97) $
  'Secrets of Dealing with Difficult People' softcover book with shipping Overseas ($46.97) $
  'The Healing Place' 2CDs with shipping to Canada & U.S. ($29.94) $
  'The Healing Place' 2CDs with shipping Overseas ($37.46) $
 

'Shrink in a Box' Stress Management System with shipping

($57.88)

$
 

'Shrink in a Box' Stress Management System with shipping Overseas ($66.38)

$
  All advertised bonuses will be included with your order. Free
 
Calculate Your Total:
$

 

MAIL THIS FORM TO:
Wellspring Personal Effectiveness
213 - 5325 Cordova Bay Rd

Victoria BC, Canada  V8Y 2L3
   

Please enclose your Cheque or Money Order payable to:

Dr Mark Lauderdale

Thank you.

For Assistance Please contact us.