Art to Heart Order Form

ORDER FORM

Ordered By:

Name___________________________

Address_________________________

City____________State___Zip______

Daytime phone___________________

Email___________________________

Ship To or Gift Address

Name___________________________

Address_________________________

City____________State___Zip______

Gift Message____________________

_______________________________

Please send me ____ copy(ies) of

Finding A Safe Place in Your Body at $14.95 ______
plus tax @1.12 per tape (7.5%) ______
plus shipping & handling ______
for a Total of ______

Make checks to Meagan Pugh
mail order form to 790 Daniel Street, Sebastopol, CA 95472

S Shipping & Handling
Before tax orders of	add
0 - $14.99	$2.00
$15.00 - 54.99	$3.00
$55.00 - 74.99	$4.00
over $75	$5.00