Dear Janice and Doug,

Please send me (___) copies of YOUR HEALTH IMPROVEMENT NOTEBOOK.

Enclosed is $4.95 per copy plus $3.50 postage and handling for first Notebook

and $1 S/H for each additional notebook in the USA.

NY residents please add 8.125% sales tax on order total.

INTERNATIONAL shipping via USPS First Class International Mail.

To Canada:  $4.00 for first notebook; add $2.00 for second notebook.

To Australia, NZ and the UK: $7.00 for first notebook; add $4.00 for second.

All other locations please email for shipping quote.

We accept PayPal, Money Orders and checks drawn on US banks.

NAME______________________________________________________

ADDRESS___________________________________________________

CITY_______________________________________________________

STATE_______________________ZIP CODE______________________

COUNTRY____________________POSTAL CODE__________________

Please circle cover color selection or standard tan cover will be sent:

GREEN          PINK          TAN         BLUE          YELLOW

Please make check or Money Order payable to D. Ewing and mail with order form to:

                                                       D. EWING

                                                 1 Margaret Street

                                               Red Hook, NY 12571

THANK YOU FOR YOUR ORDER.