Product Order Form
Name
Doctor's Name
Street Address 1
Street Address 2
City
State
Zip Code
Telephone
E-mail
Billing Address
Shipping Address
Check the boxes for the products you wish to order.
Note: Unless otherwise indicated, prices do not reflect shipping charges.
Beyond Resolution
$495 (
price includes Shipping
)
Essays on Management of an Orthodontic Practice
[ Book and accompanying CD ]
$495 (
price includes Shipping
)
Annual Vertical Calendar
$25.00
Please contact me to confirm the order and payment method for the above products.
You may also print this form, and send or fax it to:
Hummingbird Associates
P.O. Box 10279
Bainbridge Island, WA 98110 USA
Fax
(206) 842-6952 or
Call
(800) 552-7558
Thank you for your order!
