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"My Personal Health Record Diary"
Price per Book: $14.95 (Canadian) or $12.95 (US)

 

ORDER FORM

Number of Books_____ @________ = $________

ADD: Shipping and Handling................$________
(Shipping = Canadian $2.00 / US $2.40)                                     

SUBTOTAL............................................$________

G.S.T. (7% Canadian Orders Only)......$________

TOTAL AMOUNT ENCLOSED..........$________

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STREET:______________________________________________

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PROVINCE/STATE:______________________________________________________

COUNTRY:____________________________________________

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TELEPHONE: (      ) ______________FAX (      )___________
E-mail____________________________________
 

Please make your cheque or money order payable to:

        "Lynnewil Productions"

         Box 55006
         Knottwood RPO
         Edmonton, AB
         Canada, T6K 4C5

(Please allow up to 3 weeks for delivery)

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