DARREN'S ON-LINE ORDER FORM"THOUGHTS AND EXPRESSIONS - The Book" (_____) Check here to order ...............................................................#________ x $ 20.00/each = __________ "Light Bottle-poetry Item:_______ " (_____) Check here to order ...............................................................#________ x $ 15.00/each = __________ "Light Bottle-poetry Item:_______ " (_____) Check here to order ...............................................................#________ x $ 15.00/each = __________ "Light Bottle-poetry Item:_______ " (_____) Check here to order ...............................................................#________ x $ 15.00/each = __________ "Light Bottle-poetry Item:_______ " (_____) Check here to order ...............................................................#________ x $ 15.00/each = __________ "Teaching Disc Item:_______ " (_____) Check here to order ...............................................................#________ x $ 5.00/each = __________ "Teaching Disc Item:_______ " (_____) Check here to order ...............................................................#________ x $ 5.00/each = __________ "Teaching Disc Item:_______ " (_____) Check here to order ...............................................................#________ x $ 5.00/each = __________ "Teaching Disc Item:_______ " (_____) Check here to order ...............................................................#________ x $ 5.00/each = __________ ...................................................................................................................... Sub-TOTAL...............$__________ ...................................................................................................................... Shipping .................. $ 10.00** ...................................................................................................................... TOTAL COST ...........$__________ Please complete the following: Name: _______________________________________________________________ Address: __________________________________________________________________ Town/City: ____________________________ Province/State: ___________________________ Code: ___________________________ *e-mail address: ___________________________ or *Phone #: ______________________________ *(For confirmation purposes only) - ** shipping higher outside Canada ** |
Home Page | payable to "Darren Parberry" and mail it to: 10-6 Greenbrook Drive, Toronto, Ontario, Canada, M6M 2J9 For e-transfers, please email me |