Name:__________________________________________________________

Complete Address:________________________________________________

________________________________________________________________

________________________________________________________________

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Quantity	Item	Price per 5-pak	Total Price
_____ sets of 5	Needle Phobia Reprints	$ 10.00	$ _________

Price is $10.00 for each set of 5 reprints.
(Maximum order is 5 sets 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:

• Check or money order for $___________

• Mastercard
• VISA
• American Express

Credit Card Number:___________________________________

Expiration Date:_____________________________

Name on Card:________________________________________

Mail order to:	Colorado Futurescience
	2405 Eagle View Drive Colorado Springs, CO 80909 USA