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Please print this page, fill out the requested information and submit it with your check or money order.

NAME:
MAILING ADDRESS:
CITY:
STATE / ZIP:
EMAIL:
DAYTIME PHONE:
PROGRAM NAME:
Credit Card Information
CREDIT CARD NO.:
EXPIRATION DATE:
SECURITY NUMBER: (ON BACK OF CARD)

	Item Cost	00
	Quantity
	Sales Tax (IL Residents Only)	7.75% x TOTAL COST
	Subtotal with Tax (if applicable)
	U. S. Shipping	$9.95 per 3 book order
	TOTAL COST


SEND YOUR ORDER FORM TO:
Warmly, Eileen 1908 Kingsbrook Wheaton, IL 60187 For any additional questions, contact us at 847.721.6945.