Order Form for Fibromyalgia Exer

Order Form for Fibromyalgia Exercise DVDs (a secure site )


Price: $30.00 for the first DVD
           $22.00 for all other (inclusive of postage and handling)
Instructions: Please fill out the details below with the name and address to which the DVD(s) should be sent. After specifying the DVDs you wish to receive, please calculate the total cost and complete your credit card details.

     Your E-mail Address


Last Name

First Name

Address

City / Town
State
   Zip Code

Phone (in case of queries)

            Requested title(s)

DVD Title
Number
ordered

Balance and strength

Stretching and relaxation

Aerobic exercises

Total number

Total Cost
$



      Credit Card Details
      (only Visa and MC accepted)

              Amount to be charged to credit card from TOTAL above
            $    (to Oregon Fibromyalgia Foundation)

           Card Number
                    (e.g. 1111-2222-3333-4444)

           Expiration date
                    (e.g. 10/01/04)

           Name on Card
                 (as it appears on Card)



              Please click just once!

               Return policy: Returned DVDs will be assessed a $6 charge to cover
                                      shipping and processing.

    Please address queries to: orders@myalgiateam.com                                                 HOME