Fax Order Form

for
How to Write and Deliver a Loving Eulogy
by Leo Seguin

Please Print this Form, Fill it out and Fax it to

780 349 6301

Check What you wish to Order on the Form Below

  • ____ $9.95 U.S. Dollars ($12.95 Canadian) for the Printed Book
  • ____ $4.00 U.S. Dollars ($5.95 Canadian) Shipping of the Printed Book by Mail
  • ____ $9.00 U.S. dollars ($12.95 Canadian) for the Book, with Delivery by Email
  • ____ Total

Indicate U.S.( ) or Canadian( ) currency

Name: ________________________

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Card No: _____________________________

Expiry Date: _________________________

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Updated 13 August 1999