Book Order Form


	TO ORDER RUTH MITCHELL GOLLADAY'S BOOK:

You may either:

1. Complete and print this form and mail it to:
Equine Therapeutic Center, Inc.
Post Office Box 882

Hardy, VA 24101

OR

2. Complete and print this form, call 540-297-7875 and leave the requested information.

*Qty.*	*Description*	*Unit Price*	*Amount*
	Facilitated Healing Through Myofascial Release	$ 60.00
	Sales Tax 5% (Virginia residents only)
	Shipping / Handling (International add $6.95)	4.95
			*------------*
	TOTAL DUE	------>

*Name:*	_______________________________________________
*Address:*	_______________________________________________
*City, State, ZIP:*	_______________________________________________
*Phone:*	_______________________________________________
*E-Mail Address:*	_______________________________________________

*MC / Visa Card #:*	_______________________________________________
*Expiration Date:*	_______________________________________________
*3 Digit Security Code (on back of card):*	_______________________________________________
*Signature:*	_______________________________________________


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