Please print this form to your printer so that you may either:
Mail it with a check / money order
or
Fax it to us with a Master Card or Visa number.
Your First Name_________________________________________
Last Name_____________________________________________
Shipping Address________________________________________
Apt. #_____________________
City:_________________________State/Prov._______________
Zip or PC_____________________Country____________
Telephone (____)_____--_________ Fax (____)_____--_________
For Order Marriage Enrichment's Relationship Program:
as a couple ( ) $79.95 US
as a single ( ) $69.95 US
For Ordering Book:( ) Audiocassette:( ) Video:( )
(print below)Title (s) (print below) Cat #'s (print below) Price
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-
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Method of Payment:
Master Card: ( ) Visa Card: ( ) Check: ( ) Money Order: ( )
Card #______________________________Exp_____/19____
e-mail address_________________@________________________
Mail or Fax to:
Marriage Enrichment (CAN) Inc.
1224 Cedar St., Oshawa, Ont., L1J 3S2 Canada
Fax: (905) 721-9488
return to Marriage Enrichment's home page www.more-fun.com/relationships
to leave us a comment or suggestion: w@more-fun.com