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Video Course Order Form


Print this form and mail it to the address below

Product Price Quantity S&H Subtotal

ecc Video Course 		$250.00   $10.00   


Send to:

Name_______________________________________________________

Address____________________________________________________

Address____________________________________________________

City____________________  State_________  Zip _____________

Country____________________________________________________

Phone___________________    E-mail_________________________


Total:   _____________________

Check  _____      Money Order _____

Additional information:________________________________________

_______________________________________________________________
We ship USPS Priority Mail for US orders, and Air Mail for International orders.

Please send your check or money order to:

Serenity Systems
Dr Brad May
3333 Pierson Dr.
Wilmington, DE 19801
www.ecctherapy.com
info@ecctherapy.com
302-494-7066