Order Form - Only $14.95 + S/H

Stress Management Device by:
Egeberg & Associates

Personal Identification

Full Name

E-mail Address

Phone Number

()

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Payment

Please indicate your method of payment (currency must be in US Dollars only*)

We welcome the following cards:

Money Order
Check
Credit Card: (Please fill out the required information below)

For mail-in orders, please send your check or money order to:

Egeberg & Associates
27986 Peach Orchard Rd
Easton, Maryland 21601

Card Name
Expiration Date (month/year)
Card Number

Quantity

Final Cost

Each unit costs $14.95 and there is a $4.95 shipping and handling charge. All orders are shipped via UPS Ground. Please allow 3-4 weeks for delivery.

YES! I hereby agree to purchase this product! I have no objections to submitting my customer information details over a non-secure server.

(Note: This box MUST be checked for your transaction to be valid. Please read the above statement carefully and check the box ONLY if you agree to the terms.)

Submission may take a little while, so please be patient. If you chose to pay by credit card but do not wish to submit your card number online, you may call us at 410-310-3162 to complete your order.

*To pay in other than US dollars, please email your information to tegeberg@egeberg.com and the currency you wish to pay in and we will email you back if this is possible and how the transaction will occur.

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