Version # 10950
Send to Future World

Postal Chamber 153588 . Irving . Texas , 75015-3588 . USA
Phone (972) 399-8400 - future@onramp.net - Fax (972) 399-8300

Name____________________________________________________________

Address___________________________________________________________

City_______________________ ST/Prov______________Zip/Post___________

Nation______________________________________________Date___/___/___

Telephone#____________________________(in case we have questions about your order)

Please send me the following MindWriter Subliminal Tapes:

....Item#.......Quantity........................Description.........................................Unit Price......Total

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________/_________/_________

_________ /________ /____________________________________ /_________/_________

_________ /________ /____________________________________ /_________/_________

..........................................................................................................SUBTOTAL:__________A
........................................................................................Texas Sales Tax 8.25%:___________B
................................................(See Shipping Instructions) Shipping & Handling:___________ C
....................................................................................................(A+B+C) TOTAL____________

Payment Method: ( ) Cash ( ) Check ( ) Money Order ( )Credit Card
Credit Card Number_______________________________________
( ) MC ( ) Visa ( ) Amex ( ) Diners ( ) Access ( ) Carte Blanche
Expiration Date ____/_____X__________________________________________Signature
Name of Cardholder_________________________
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