Mail and Fax Order Form
To order, print out this form on your computer. You can mail or fax your order
to Empowered Within. We do accept phone orders
at (541) 227-3633. Fax # 1-866-365-0991. Office hours: Monday-Friday,
9am to 6:30pm, PST.
| Quantity | Item | Unit Price | Total |
Subtotal |
$__________ |
| Delivery Confirmation Charge for USA residents. Add $ .55 | $__________ |
| Shipping (Add 10% to your subtotal for regular mail) | $__________ |
| Priority Mail Shipping add $4.05 for USA. Global Priority Mail add $7.95 for Canada and $9.95 for United Kingdom | $__________ |
TOTAL |
$__________ |
You may pay by personal or business check, money order, school/institution
Purchase Order, or Visa/MasterCard/American Express/Discover.
Make your check or money order payable to Empowered Within.
If paying by credit card, please include:
Credit Card Type:__________________
Credit Card #:_____________________________________________ Exp:_________
CVC #:_____________ (last three digits on back of the credit card)
Name that appears on the credit card:________________________________________
Ship to Address:
Business Name:__________________________________________________
Name:_________________________________________________________
Adress:________________________________________________________
City/State/Zip___________________________________________________
Country:________________________________________
Phone:_________________________________________
Email Adress for confirmation:______________________________@___________
Business Purchase Order # or Invoice:_____________________
Retail, Hospital, Hospice, Schools, and Purchases
by Business Owners Only
A 20-30% deposit is required on large orders and balanced is paid within 30-days
from ship date. If you order 1-7 Adult CDs, the price is $12.95 each. If you
order over 8 Adult CDs the price is $11.95 each. If you order over 15 Adult
CDs, the price drops to $10.95 per cd. If you order 20+ Adult CDs, the price
drops to $9.95 per cd. Regular wholesale price is $18.95 per Adult CD. Child
and Teen CD: 1-7 $10.95, 8-15 $9.95 and 20+ $8.95 each. Regular Wholesale price
is $16.95 per Child and Teen CD. For all orders over 20 CDs, shipping
is FREE within the U.S.A..
Do you need any marketing materials or brochures:_____________________________
Send Order Form to: Empowered Within, P.O.Box 1761,
Klamath Falls, Oregon, 97601
Telephone: (541) 227-3633 ~ Fax #: 1-866-365-0991
Email: empoweredwithin@yahoo.com ~ Website: http://www.empoweredwithin.com