Mental Golf Order Form

Print this form and
Fax {910} 256.7464
(with credit card information)
or Mail to:
Dr. Donna LaTreill/ Mental Golf, Inc.
1745 Signature Place
Wilmington, NC 28405
{Send check, money order, or Western Union}

Name:  
Address:  
City, State, Zip:  
Country:      
Phone:        
Payment Type: Check  Money Order Western Union (circle one)
 
Credit Card: Visa  Mastercard   (circle one)
Card No:  

Expiration Date:

  
         
         
Quantity:   

Mental Golf Video $24.95 (ea):

 
   

Shipping and Handling:

4.95
     

$29.90
   

Add $15.00 for International Orders >

  
   

Add $15.00 for Express Mail >

  
   

Total: