Order Form for Living with a Disability, A Maine Guide to Relaxation and Stress Management and Complete Crisistapes Program.
| Program | Price | Quantity | Total | |
| Living with a Disability | $24.95 | x | ________ | $______ |
| A Maine Guide to Relaxation and Stress Management | $19.95 | x | ________ | $______ |
| Complete Crisistapes Program | $49.00 | x | ________ | $______ |
| Maine Residents, please add 5% sales tax | $______ | |||
| TOTAL | $______ | |||
| Name: | _______________________________________ | |||
| Business: | ___________________________________ | |||
| Shipping Address: | ___________________________ | |||
| ___________________________ | ||||
| ___________________________ | ||||
| Telephone: | ___________________________ | |||
| ___ | Check or money order enclosed payable to R.L. Breazeale, Ph.D. |
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| ___ | Visa/Mastercard - Card #: ____________________ Exp. Date:___________ |
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| ___ | Company Purchase Order #: _______________________________ | |||
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Order by Mail: R.L. Breazeale, Ph.D. 205 Ocean Avenue Portland, Me 04103 |
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| Order by Phone: Call Dr. Breazeale's confidential voice mail at 207 773-7993, ext. 25 | ||||