Video Order Form

Order Form

Name

Department/Title
Organization
Street Address
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Country
E-mail
Purchase Order #
Daytime Telephone Number	(please include area code)
Payment Method

	Quantity	Unit Price DVD: $299	GST add 5%	Total
Spirituality, Suffering, and Illness: Conversations for Healing
Grand Total

Please note that you will be contacted within the next couple of business days for credit card information.
All parts of this form must be completed.

You will not be transferred to another page once you click submit,
so in order not to be charged for duplicate orders, please do not click Submit twice.