Mind Over Fatter Order Form

Checks and money orders for Mind Over Fatter payable to:

Gina Paulhus
4 Vale St.
Merrimac, MA 01860

Please enter your payment information:
Date: / /
Name: ______________________________________
Address: ___________________________________
___________________________________
State: ____ Zip: ________
Phone: _____________________________
Email: _____________________________

Ship to:
Same: Y/N

Name: ___________________________________
Address: ___________________________________
___________________________________
State: ____ Zip: ________
Phone: _____________________________
Email: _____________________________

We currently accept all major credit cards, personal checks, and money orders. To pay by credit card, enter your card information below, or pay online with our secure server. Visit www.homeexercisecoach.com and click on the “Mind Over Fatter” button on the left of your screen.

Item: Mind Over Fatter, paperback
Quantity: ____ x $20.94 (MA w/ tax) or $19.95 (NH, no tax)
Subtotal: $________
+ $________ Shipping charge
($4.00 for first book, $1.00 for each additional book.)
Total: $_______ Payment method:(please check one)
( ) Check or money order
(please enclose, and make checks payable to: Gina Paolino)
( ) Bill me later (invoice will be issued in 30 Days)
( ) Credit Card:

Type of card: _____________
Card number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name as it appears on card:
Expiration date: __________
Cardholder’s Authorization: (please sign)


___________________________________

Thank You for your order!

Orders are usually shipped within 24 hours of your payment. Pay online by credit card for fastest shipment: Order Mind Over Fatter--pay with a credit card.

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