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| For your convenience we accept
all major credit cards or electronic fund transfer. 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) |
Credit Card Information: |
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| Date: __________*Important:
Date Must Have Product(s) ___________ PO No. ___________ |
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Shipping and Handling Charges for contiguous
US (Please circle your choice) |
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