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| For your convenience we accept
MasterCard, Visa, and Discover, or electronic fund transfer.
Sorry, we don’t accept American Express.
Place your order by fax, e-mail, phone, or mail. Make checks
made payable to CCC (Coalition of Counseling Centers) (Fed.
ID No. 94-2775546). Questions? Please call or e-mail. |
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| PRINT THIS FORM, FILL IT OUT,
AND FAX OR MAIL IT TO PLACE YOUR ORDER. YOU MAY ALSO PHONE
OR E-MAIL US WITH YOUR ORDER. |
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| Shipping
Address: (NO P.O. BOX FOR UPS) |
MC, Visa, or Discover Information: |
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| Date: ________________*Important:
Date Must Have Product(s) ____________________ PO No.
___________ |
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Shipping and Handling Charges for Continental
US (Please circle your choice) |
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