PRO$PERITY NETWORK FAX ORDER FORM

PRO$PERITY NETWORK
(323) 930-2994
Mail To: P. O. Box 11091
Beverly Hills, CA 90213
Fax To: (323) 930-2994

Please use this form for Mail and Fax Orders - print the form and mail with your check to the address above - or fax this form to (323) 930-2994.

What kind of transaction would you like to send?

Check Money Order Fax Order

Please enter your Order in the space provided below -
        Name and Price of Book or Tape
        See bottom of page for shipping charges.
           California Residents please add 8% Sales Tax

Tell us how to get in touch with you:

Name
Address1
Address2
City/State/Zip
E-mail
Tel
FAX

Credit Card Information (for fax orders only)

Name on Card
Card Type
Account No.
Verification Code

Please contact me as soon as possible regarding this matter.

* CA. Residents Add 8.25% Sales Tax

* Shipping Rates are:

Purchases Up to $20.00 - $ 5.75
Purchases $21.00 - $40 - $ 6.75
Purchases $41.00 - $60 - $ 7.75
Purchases $61.00 - $80 - $ 8.75
Purchases $81.00 - $100 - $ 9.75
Purchases $101.00 - $120 - $ 10.75
Purchases $121.00 - $150 - $ 11.75
Purchases Over $151.00 - $12.75