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Smoking Release
Order Form --
We
accept:   
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Selected
Item
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Tax
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Shipping
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Total
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Number on
Credit Card*
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Expiration
Date
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Name
(as shown on credit
card)
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Address
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City/ST/ZIP
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Telephone
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Best Time to
reach you
(include your time zone,
please)
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E-mail
Address
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Comments
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Thank you for your order. Your order will be
expedited. Please let us know via the comments section
(if ordering a program or kit) if you'd like us to
send the first phase via e-mail. If you request this
free option, you will also receive a hard copy of the
first phase with your program or kit.
Be sure to read and understand the "Fine Print" and
coaching use policy found at: www.smokingrelease.com/gorder.html#guarantees
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* Note: Credit Card information is
not secured. If you prefer, send your order by FAX or
regular mail after printing this form.
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