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(this form will require a printer and fax machine)
Quick Instructions:
Fill out the form below
- Be sure to check off the items you would like to purchase
- Remember to include your mailing address
- Include payment / credit card information
- Print this form ...
- Sign the form ...
- Fax signed form to 1-919-942-0700
- Or Mail signed form to:
PATHWAY SYSTEM
3011 Jones Ferry Road
CHAPEL HILL, NC 27516
Using the following form will speed your order and ensure mailing to proper address
4 Easy Steps !
#1 select the items you wish to order
FACING PANIC: Self-Help for People with Panic Attacks...$15.00 NEW
DON'T PANIC (Book)...$15.00
DON'T PANIC SELF HELP KIT...$79.95
DON'T PANIC KIT plus BOOK...$89.95
ACHIEVING COMFORTABLE FLIGHT...$59.95
STOP OBSESSING...$16.00
STOP OBSESSING AUDIO TAPE SERIES...$24.95
#2 determine the amount to be billed
SUB-TOTAL
Shipping ($5.75 for 1st item, $.85 each additional, in USA)
North Carolina Residents add 7% Sales Tax
TOTAL
#3 Enter your mailing information
Full Name
Address Line 1
Address Line 2
City
State
Zip code
phone number
e-mail address
#4 enter billing information , print and sign
Check / Money Order
Credit Card (type) Visa / Master Card
Purchase order (attach purchase order)
Credit Card number:
Expiration Date:
Name
(if different from above, as it appears on credit card)
Address
(if different from above, as it appears on credit card)
Address Line 2
(if needed)
City
State
Zip code
Phone number
Please read: By filling out, signing and faxing this form I authorize Pathway Systems to bill the credit card I listed above for only the items I have checked on this order form.
My signature___________________________________
Date ________________
Or call this toll-free number for a free brochure on these Self-help resources available from Pathway Systems and Anxieties.com 800-394-2299 (toll: 919-942-0700)
next: The Don't Panic Self-Help Kit: The Homework Guide to Conquering Your Fears
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