Dr. Rita Louise Book Order Form

Avoiding the Cosmic 2x4 Book

The Power Within Book & CD

DaKara Kies Company P.O. Box 4338 Everett, WA 98204

(425) 267-9730 OR 1-800-813-3877 FAX 425-953-4304

Print out, complete, and mail this form to the address above

E-mail: (Cut & Paste form): dakara@dakara.com

Ship to:

Name:_________________________________________________________________

Address :_______________________________________________________________

City:____________________________________ST________ ZIP_________________

E-Mail Address__________________________________________________________

Phone#(_______)________________________________________________________

VISA/MASTERCARD #___________________________________________________

Exp _____-_____ CVV # ________

Signature______________________________________________________

Billing Address if same as Shipping write SAME

Address:___________________________________________________

City:___________________________ ST __________ ZIP______________

Item Description	Qty	Price	Total
Avoiding the Cosmic 2x4 Book	____	$18.95	$_____________
The Power Within Book	____	$16.95	$_____________
The Power Within CD	____	$15.00	$_____________
The Power Within Book & CD set	____	$30.00	$_____________

Subtotal			$_____________
Shipping & Handling (See Chart )			$_____________
Washington State Tax 8.9% (Orders shipped within Wash St. Only)			$_____________
Order TOTAL			$_____________

Shipping & Handling (continental US only)

1 Book/Item $5.00

Each additional item $2.00

Call for Bulk Shipping quote 800-813-3877

Surface (Foreign countries): add $5.00 (USD) to prices above. Please allow eight weeks for your order to arrive.

Air (Foreign countries): add $7.50 (USD) to prices above.

These shipping and handling charges are estimates. In some cases it may be necessary for charges to be adjusted.

DaKara Kies Company is committed to the preservation of the Earth and makes a concerted effort to use and reuse recyclable materials. You may receive you order in an unusual package or with a combination of packing materials. We urge you to reuse whatever you can of the packing materials.

Thank you for your order!

Please email/mail or fax this completed form to the address above or call with your Visa/Mastercard number.

Email to: Dakara@Dakara.com

Mail to: Dakara Kies Co
P.O. Box 4338 Everett, WA 98204