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RUSH ORDER FORM Customer Information

Name (Please Print):                                                                                     

Address:                                                                                                         

City:                                         State:                   ZIP:                  

Country:                                     Phone:                                               

Email:                                                                                                             

Birth Date (required for charts):

Day:                   Month:                   Year:                  

Order Items

Item

Price

Qty

Total

How to Win Games of Chance

$35.00

              

 

Domestic Postage & Handling

$5.00

              

 

Outside U.S.A. Postage & Handling

$10.00

              

 

The DNA of Numbers

$30.00

              

 

Domestic Postage & Handling

$5.00

              

 

Outside U.S.A. Postage & Handling

$10.00

              

 

How to Get the Zero Using Dice (Book – Collector’s Item)

$20.00

              

 

Domestic Postage & Handling

$5.00

              

 

Outside U.S.A. Postage & Handling

$10.00

              

 

I CHING CUBES™

$50.00

              

 

Domestic Postage & Handling

$4.00

              

 

Outside U.S.A. Postage & Handling

$10.00

              

 

Biorhythm Charts

Chart Type

Duration

Price

Qty

Biorhythm Chart – Black & White

6 Months

$40.00

              

Biorhythm Chart – Black & White

Full Year

$60.00

              

Color Biorhythm Chart with Intuitive Cycle

6 Months

$35.00

              

Color Biorhythm Chart with Intuitive Cycle

Full Year

$55.00

               

Note: Be certain to include your birth date on the front or back of this form.

Payment Summary

Total Enclosed: $                                                   _

Payment Method (check one) []Cash (immediate delivery)

[] Postal Money Order (immediate delivery)