order form

registration form

Type in your information below completely, then use the book print button above to print and mail. Order by mail today with a check or Money Order and Save 20%! You may also fax this form when using a credit card; however, the 20% discount does not apply.

Please send my Registration Key for 'Secret Herbal Formulas'. Enclosed is:

Click the Appropriate Button:   A check for $19.96 USD
A Money Order for $19.96 USD MasterCard for $24.95 USD
Visa for $24.95 USD

(Enter your Email Address correctly as it must be accurate for delivery of your Registration Key)

Email:

Your Name:

Address:
(We need your correct address to create your Registration Key. If you are paying by credit card, enter your correct credit card billing address, here and for city, state, and zip.)

City:

State:

Zip:

Telephone:

(If Registering by credit card)
Credit Card Number:

Card Expiration Date:

Your Name as it appears on the card:

Comments:

Thank you for Registering!

Mail to:
Kathleen Barton
PO Box 325
Worden, MT 59088 USA

Or Fax Credit Card Order to:
406-967-2446

You can return to the main part of the book with the links below.