Once you PRINT THIS ORDER FORM you can either FAX  OR  MAIL it to us:

Our FAX number	206-888-4220
Our Address	Inspirized LLC, P.O. Box 841167, Houston TX 77284-1167

Your Order

Product Description (Please fill in yellow spaces as appropriate)	Quantity	$ Unit Price	Line Total
Positive Energy – 4 Programs CD set (Promotion offer)		59.80
Train Your Mind to Succeed – CD Program		24.90
Great Self Confidence – CD Program		24.90
Financial Freedom & Abundance – CD Program		24.90
Great Professional Success – CD Program		24.90

Subtotal
Shipping & Handling  +  12%
Total

Your Name, Address and Credit Card Information

First Name (as it appears on your credit card)
Last Name (as it appears on your credit card)
Street Address
City
State
Zip Code
Home Telephone Number
Email Address (to confirm your order)

Credit Card Type (check one)	--------------------
Credit Card Number
Expiration Date	Month: __ __    Year: __ __
Card Security Code On the back of your card, locate the final 3 digit number. The American Express security code is a 4-digit number printed on the front of your card. It appears after and to the right of your card number) What is this? Using Amex?

Shipping Address - Only IF different from above:

First Name
Last Name
Street Address
City
State
Zip Code

Home  |   Train Your Mind to Succeed   |  Financial Freedom and Abundance   |  Achieving Professional Success   |  About   | 
Contact Us   |  Privacy Policy   |   Sitemap

©2009 Inspirized LLC, All Rights Reserved.