Niara Healing Arts Productions

PO Box 480 Modena, NY 12548

Phone: 845-256-5430

 

Order Form                                            Date_______________

 

Ship To:

Company or Institution ________________________Attention __________

 

Address ______________________________________________________

 

City_____________________ State________________ Zip Code_________

 

Contact_________________________ Phone ________________________

 

Fax  ___________________________ Email _________________________

 

Shipping and Handling

Unit Price: $5.00 via Priority Mail (USPS) – 2-5 Business Days

Item Number                     NHA003DVD (Advanced Pregnancy Massage Techniques)  or NHA002DVD (Partners in Pregnancy)

Quantity                           _____________Units

Amount Enclosed               _____________

Subtotal                           _____________

Shipping/Handling             _____________

8.00% NY sales tax           _____________ (applicable for purchases in NY only)

Total                              _____________

Check Number                  _____________        Credit Card _______     Card Number ________________________

                                                                      Expires       _______    Last three numbers on back of card ______

 

Special Shipping Instructions_______________________________________________________________________

______________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________