Book Order Form

You may either:
1. Complete and print this form and mail it to:
Equine Therapeutic Center, Inc.
Post Office Box 882
Hardy, VA  24101

OR

2. Complete and print this form, call 540-721-4545 and leave the requested information.

Qty. Description Unit Price Amount
Facilitated Healing Through Myofascial Release $    60.00
Canine Myofascial Release (CD Format) $    60.00
Sales Tax 5% (Virginia residents only)
Shipping / Handling (International add $10.95) 6.95
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TOTAL DUE ——>
Name: _______________________________________________
Address: _______________________________________________
City, State, ZIP: _______________________________________________
Phone: _______________________________________________
E-Mail Address: _______________________________________________
MC / Visa Card #: _______________________________________________
Expiration Date: _______________________________________________
3 Digit Security Code     (on back of card): _______________________________________________
Signature: _______________________________________________