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NAME:____________________________________________________

STREET ADDRESS:__________________________________________

CITY:____________________________________________________

STATE:___________________ZIP:___________________________

COUNTRY:_________________________________________________

PHONE:______________________ BEST TIME TO CALL:__________

Please send me ______copies of Living With Your Successes .

Enclose US$ 12.95 plus US$ 2.00 shipping and handling for each workbook ordered. (For orders shipped outside the US, please add US$ 5.00 shipping and handling per book.) Virginia residents add 4.5% state sales tax.

Number of Workbooks ___________________
At $12.95 each: _____________________
Sales Tax if applic. ______ ______________
Shipping & Handling ___________________
Total ___________________________

ENCLOSED IS MY CHECK OR MONEY ORDER IN U.S. DOLLARS FOR $________

Allow 3-4 weeks delivery within U.S.; 6-8 weeks outside U.S.
Thank you for your order.

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