Order Form for Living with a Disability, A Maine Guide to Relaxation and Stress Management and Complete Crisistapes Program.

 

ProgramPrice QuantityTotal
Living with a Disability$24.95 x ________$______
A Maine Guide to Relaxation and Stress Management$19.95 x ________$______
Complete Crisistapes Program$49.00 x ________$______
Maine Residents, please add 5% sales tax$______
TOTAL$______
Name: _______________________________________
Business: ___________________________________
Shipping Address: ___________________________
  ___________________________
  ___________________________
Telephone: ___________________________
___ Check or money order enclosed
payable to R.L. Breazeale, Ph.D.
___ Visa/Mastercard - Card #: ____________________
Exp. Date:___________
___ Company Purchase Order #: _______________________________
Order by Mail: R.L. Breazeale, Ph.D.
205 Ocean Avenue
Portland, Me 04103
Order by Phone: Call Dr. Breazeale's confidential voice mail at 207 773-7993, ext. 25