Home Akashic Reader The Akashic Records Inner Signature Classes Teaching CDs Gemstones! Fax Order Form

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

PRINT and MAIL this Page to:
Roberta S. Herzog Foundation, Inc
P.O. Box 10382
McLean, Virginia 22012-8383

 

Name ______________________________________________

Address____________________________________________

City, State, Zip_______________________________________

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

Item or services:  ______________ @ ___________ $ ______________

Number of books  _______@____________$ ___________

Number of The Akashic Record CDs   ______@  $_______

Shipping and Handling..................................... $ ____________
International orders shipping cost will be quoted by Roberta
Total Enclosed................................................ $ ____________
 

Please enclose 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 MAIL this Page to:
Roberta S. Herzog Foundation, Inc
P.O. Box 10382
McLean, Virginia 22012-8383

Home Akashic Reader The Akashic Records Inner Signature Classes Teaching CDs Gemstones! Fax Order Form

E-mail: iamlux@aol.com

Roberta S. Herzog Foundation, Inc
P.O. Box 10382
McLean, Virginia 22012-8383

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