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Feel free to print this form and fax it to us at 866-468-4555 or mail it to:

Child Like Consulting, Inc. 
700 E. Rambling Drive,
Wellington, FL  33414

Ship To:

Name:________________________________________________________________________

Address:_____________________________________________________________________

City:___________________________________ ST:_________ Zip:_____________________

Telephone:__________________________________________________________________

Title  # tapes @ 10.95  # CD @ 14.95  # Book/vid/DVD Total Amount
         
         
         
         
         

                                                                                          Subtotal    ____________
                                                                      FL residents sales tax____________
                                                                         Shipping & Handling____________
                        Total______________
 

Shipping Costs:

1-3 items = $4.00
4-6 items = $7.00
7-9 items = $9.00
10-12 items = $10.00
 13- 15 items = $12.00  

Payment Method:
__________Check or Money order enclosed (Made Payable to "Mr. AL")
__________Charge my _____visa _____mastercard _____Amex _____Discover

Card Number:_________________________________________________
Expiration Date:______________________
Billing Address for Credit Card:____________________________________

Signature:_____________________________________________________

Thank You For Your Order!!!!