Order Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=100 BGCOLOR="#0000FF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>Order Form</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="A Hand for Your Life"><U><B>home</B></U></A></div> <div> Order Form</div> <div> </div> </td> </tr><tr> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <bR> <div> <B>Order Form</B></div> <div> There are three ways to order one of Dr. Tooley's books or eCourses. </div> <div> 1) Call 1-919-467-2464 and leave a message with Nancy including book or course title(s), your name, address, telephone number and credit card number.  </div> <div> 2) Copy the following form and fax it to 919-467-8653.</div> <div> 3) <A HREF="mailto:doctorjoe98@earthlink.net" TARGET="_top" TITLE="mailto:doctorjoe98@earthlink.net"><U>Email Dr. Tooley</U></A>.</div> <div> ______________________________________________________</div> <div> Name:</div> <div> Street address:</div> <div> City:</div> <div> State/Province:</div> <div> Zip/Postal code:</div> <div> Work Phone:</div> <div> Home Phone:</div> <div> FAX:</div> <div> E-mail:</div> <bR> <div> Please provide the following ordering information:</div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="348" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <B>Quantity</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="260"><div> <B>Description</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="57" ALIGN="bottom" WIDTH="73" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="260"><div> Book--How To Raise Responsible Children--$10 + shipping and handling</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="73" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> Book--Adult At Eighteen--</div> <div> $10 + shipping and handling</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 76 WIDTH="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="76" ALIGN="bottom" WIDTH="73" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="260"><div> eCourse--Look at Me While I Am Talking to You</div> <div> $50 (2 for 1 sale--give a free course to a friend)</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 76 WIDTH="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="76" ALIGN="bottom" WIDTH="73" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="260"><div> eCourse--Continuing your Sail off into the Sunset Together</div> <div> $50 (2 for 1 sale--give a free course to a friend)</div> </tD> </tR> </TABLE></div> <bR> <div> <B>BILLING</B></div> <div> Credit card:</div> <div> Cardholder name:</div> <div> Card number:</div> <div> Expiration date:</div> <div> SHIPPING--If different from above address.</div> <div> Street address:</div> <div> Address (cont.):</div> <div> City:</div> <div> State/Province:</div> <div> Zip/Postal code:</div> <div> ____________________________________________________</div> <bR> <bR> <bR> <bR> <bR> <bR> </td> </tr></table></body>