Relaxation Creation 
Print this Form to Order by Mail

Please rush my order for the items I have requested.
I am paying for this merchandise by:
Money Order___Cashiers Check___         Credit *Card#_________________________________Exp____/_____
(Indicate one of the above)

Billing Information
NAME_____________________________
ADDRESS__________________________
CITY_______________________________
STATE & ZIP________________________
PHONE_____________________________
EMAIL_____________________________
*Billing information must mach the credit card billing information

Shipping Information
NAME_____________________________
ADDRESS__________________________
CITY_______________________________
STATE & ZIP________________________
PHONE_____________________________

Quantity

 Description (Ex: Cassette or Custom CD)  Price Shipping/
Handling ($4.95 per item) 		Sub-Total
         
         
         
     

Price Chart

Cassette (Volume l or ll) - $9.95
CD (Volume l or ll) - $14.99
DVD - $25.00
Custom Cassette - $64.95
Custom CD - $74.95
CD Vol1/Vol2 & DVD Special - $54.98

*All orders must be accompanied with payment to be processed.
**For Credit Card Orders you must include all pertinent information as outlined

Total of your order__________________

Enter Shipping  ___________

Total your Price & Shipping Cost __________

Kindly mail this order, with your remittance, to:

Sue Kleiner Grew Lcsw
P.O. Box 662
Richlandtown, PA 18955-0662
(215) 353-0007