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2 ways to order:

  1. Complete & print this form & fax it to Metroplex Hypnosis PLLC at 972-930-0675 
  2. Call 214-549-0229 and place your order

Please provide the following contact information:

Name
Work Phone
Home Phone
FAX
E-mail

Please provide the following ordering information:

QTY DESCRIPTION Price per Extended Price
Jhon's Pre-Recorded Weight Loss Program TAPE # MH9701   $29.97

Shipping & Handling

$6.50

Sales Tax (Texas)

 8.25%

Total Due

 

BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

 

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
 

Signature:_______________________________   Date:_______________________

Please allow 2-3 weeks for delivery address in Dallas/Fort Worth area.

Allow 4-5  weeks for delivery to other areas.