Please print and complete this order form and send along with check or money order payments.
Item |
Price |
Quantity |
Total |
Take Control Of Your Back |
$12.95 |
|
|
Shipping (see main order page for charges) |
|
|
Grand Total |
|
SHIP TO
Name |
|
Address 1 |
|
Address 2 |
|
City |
|
State/Province etc |
|
Zip/Postcode |
|
Country |
|
Email Address |
|
You must provide an email address so we can send your membership password and user-id to you. We will also alert you when any new articles are added to the members section. Your email WILL NOT be used for any other purpose. Please print clearly. |
Send this form along with your payment to:
Visual Encounters Inc.
Backpain Help,
P.O. Box 1046
Hightstown, NJ 08520
|