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PRINT THIS ORDER FORM FOR MAIL ORDER ONLY |
| HOULE PSYCHOLOGY CLINIC ORDER FORM | |
| SHIP TO/BILL TO: | METHOD OF PAYMENT (Choose only one) |
| Organization______________________________
Name____________________________________ Title_____________________________________ Address _________________________________ Address _________________________________ City__________________State____Zip_________ Phone (_____)_______________Ext.__________ |
P. O. No.__________________________________
Personal Check Business Check Master Card Visa Name on Card________________________________ Card #______________________________________ Expiration Date: (Month)______(Year)_______ |
Order By Title
| Quantity | Item # | Title | Price | Total | ||||
| 4001 | Make Your Septagers Want To Behave: 8 Easy Steps | $17.71 | ||||||
| 1001 | Preventive Classroom Discipline | $20.68 | ||||||
| 5001 | Mastering The Mental Side Of Golf | $15.76 | ||||||
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On orders shipped to CT addresses please add 6% Sales Tax |
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Total Due |
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| Orders from individuals must be prepaid. |
| Schools and organizations may use purchase orders. |
| We try to ship promptly, but please allow 4 to 6 weeks for delivery of mail orders. |
| Send Your Order To: | Houle Psychology Clinic |
| P.O. Box 450 | |
| Southbury CT 06488-0630 |