Order form for Needle Phobia: A Neglected Diagnosis reprints
Name:__________________________________________________________ Complete Address:________________________________________________ ________________________________________________________________ ________________________________________________________________ *******************************************************************
Price is $10.00 for each set of 5 reprints. Prices include first class mail shipping within the United States. Add $5 for shipping outside of the United Staes. All payment must be in U.S. currency. Acceptable forms of payment include Mastercard, Visa, American Express, money orders, and personal checks drawn on a U.S. bank. Credit card orders may be placed on our secure web order form. Other forms of payment should be mailed in with this printable order form. Make checks or money orders payable to "Colorado Futurescience." Enclosed is:
Credit Card Number:___________________________________ Expiration Date:_____________________________ Name on Card:________________________________________
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