Fax Order Form

Roberta S. Herzog Enterprises, Inc.
ORDER FORM
by mail or fax

PRINT and FAX this Page to:

828-628-3953

New Shipment of books has arrived!
Special package price for these 2 popular books:

AKASHIC RECORDS reg. price: 39.95

ANCIENT WIZDOM STORIES reg. price: 14.95

20% off!
sale total price $ 43.92

FREE POSTAGE IN THE U.S. ONLY

All orders in Canada and other countries,
please contact Roberta for shipping costs.

Name ______________________________________________

Address____________________________________________

City, State, Zip_______________________________________

Daytime Phone: ( ......) _________________________________
Evening Phone: ( ......)__________________________________

Item or services: ______________ @ ___________ $ ______________

Number of books _______@____________$ ___________

Shipping and Handling..................................... $ ____________

Please note: Postage for all CD orders, shipped anywhere in the United States, is FREE!
Orders sent outside the U.S., including Canada, must be shipped via DHL or UPS.

International Shipping charges must be cleared with Dr. Herzog’s office.

Total Enclosed................................................ $ ____________

Please check payment method:

____Check ____Money Order

____VISA, ____MasterCard

Credit Card # _______________________________________
3 digit auth. code on the back of card ________

Expiration Date: _____________________________________

Please print card holder's name: __________________________

Sign card holder's name: ________________________________

Billing address, if different from above:

Additional Shipping Names and Addresses:

Name______________________________________________
(Item to be shipped ____________________________)
Address____________________________________________
City, State, Zip_______________________________________
Daytime Phone: ( ......) _________________________________

Name______________________________________________
(Item to be shipped______________________________)
Address____________________________________________
City, State, Zip_______________________________________
Daytime Phone: ( ......) _________________________________

Name______________________________________________
(Item to be shipped _____________________________)
Address____________________________________________
City, State, Zip_______________________________________
Daytime Phone: ( ......) _________________________________

PRINT and FAX this Page to:
828-628-3953

E-mail: iamlux@aol.com

Roberta S. Herzog Enterprises, Inc.
P.O. Box 278
Fletcher, NC 28732 USA