Jade Woman Enterprises
363 S. Harlan Street, Suite 115
Lakewood, Colorado 80226
303-573-6533
FIVE ELEMENT ACUPUNCTURE DVD SET
THE TWELVE OFFICIALS © Warren Bellows
ORDER FORM
___________Sets @ $195.00/set (6 DVDs) $___________
Shipping and handling @ $10.00 per set $___________
Order Total $___________
Payment: Check#_________(please enclose)
Credit Card: VC____MC____
Credit Card#__________________________
Exp Date______
Signature Authorization:______________________________
Mail Order To: Please Print
Name:____________________________________________
Address:__________________________________________
___________________________________________
Phone#___________________email____________________
Mail order with payment to Jade Woman Enterprises at above address. Thank you!
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