Order Desk

Fax/mail Order Form

Please use this order form for direct orders or if you would like to be on our mailing list.

Date:____________

Name:__________________________________________

Address: _______________________________________

City: _____________ Postal/Zip:________ Country:______

Tel: ___________________ email: ____________________


I would like to order the following (please circle):

1. The complete memory course.................. US125


Please add $20 for shipping and handling in North America and $40 for international orders.

Canadian orders please add 5% GST: __________________

Total Payment: ____________________

Form of payment:

___A payment is enclosed
___Please bill my credit card:

__VISA __American Express __MasterCard

Card #: __________________________________

Expiration date: ____________

Signature: ________________________________

__Please keep my name on your mailing list for newsletters, announcements, etc. (note: we will not, under any circumstances, sell or give your information to a third party.)

Special notes: ___________________________________________________________

Please fax this form to 416 222 0020

or mail to:

DeeperDimension Publishing

148 Finch Ave. West

North York, ON
M2N 2J2

Canada