THE NEXTAGE LIGHT MISSION

Self Hypnosis Lose Weight CD

IT IS HERE - NOW!

BREAKTHROUGH - ADVANCED TECHNOLOGY FOR OUR CHANGING TIMES! PLEASE RUSH ME THE MODERN DAY 'BREAKTHROUGH'

PRIORITY ORDER FORM

Your Priority Order form for The Self-Hypnosis Lose Weight CD

Please Print Full Name ...............................................................................................

Shipping Address .......................................................................................................

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Region/Area .................................................................................................................

City .................................................................................................................................

Country .........................................................................................................................

Zip/Postal Code ...........................................................................................................

Main Contact Land Line - Country Telephone Code .........................................

Land Line Telephone Dialing Code ......................................................................

Land Line Telephone Number ................................................................................

Fax Number - if appropriate ....................................................................................

Mobile Telephone number .......................................................................................

Main Email Contact/Confirmation address ..............................................................

Back-up Email/Confirmation Address ..................................................................

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PURCHASE PRICE AND DELIVERY

Please print down this order form as a backup of additional confirmation of your order. Then attach as a priority post to the email address - salesbiobalance@hotmail.co.uk - Thank You

Purchase Price: Self Hypnosis Lose Weight CD $20.00 CDN equivalent exchange rates apply at point of order

ALL MAJOR CREDIT CARDS ACCEPTED

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PLEASE KINDLY NOTE

I confirm the details as provided here by me on my Priority Order Form, are accurate and agree to the terms as clearly stated.

Buyer/User Signature ............................................... Please Print Full Name ................................................... Date ........................................

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THANK YOU FOR PLACING YOUR PRIORITY ORDER