Reflection Order Form
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INSTRUCTIONS
We accept MasterCard, Visa, Discover, American Express, and checks or
money orders in U.S. dollars drawn on a U.S. or Canadian bank.
Mail to:
Reflection
47 Redwood Road
Asheville, NC 28804
or
sales@reflection-idea.com
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Name:
Address:
City:
State or Province:
Zip or Postal Code:
Country:
Phone:
E-Mail:
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# Item Price Each Total
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__ Reflection book US$ 12.00 ________
SUB-TOTAL ________
U.S. North Carolina Residents add 4.5% Sales Tax ________
(Shipping is free)
TOTAL (all funds payable in U.S. $ please) ________
Payment Method:
__Check (drawn on a U.S. or Canadian bank)
__MasterCard __Visa __American Express __Discover
Card #: __________________________________________________________
Exp Date: __________
Issuing Bank: __________________________________________________________
Signature: __________________________________________________________
Please tell us where you learned about us...
__an ad in_____________________ __an article in_________________
__a web site___________________ __a friend or associate
__mail from____________________ __other_________________________
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30 Nov 2004