Printable Order Form

FAX this form To:
1-902-446-4634

Or

Mail This Order Form To:
Toulany Publishing
1920 St Margaret's Bay Rd
Halifax, NS, B3T 1C3
Canada

___ Enclosed is my check, money order or credit card order for __________ copy(s) of Ray Toulany's BodyDesign Nutritional System $29.95 plus $9.50 US S&H ($13 foreign orders) each.

Totalling $_____________._______US

Charge my (Note: You can use more than one card to complete this order):

Type of Card: ____________

Card Number:________________________________________ Exp. Date:_______

Type of Card: ____________

Card Number:________________________________________ Exp. Date:_______

Type of Card: ___________

Card Number:________________________________________ Exp. Date:_______

Signature: __________________________________________
Print Name: _______________________________________________________________________

Address 1: _________________________________________________________________________

Address 2: _________________________________________________________________________

City: ______________________________________ State: ______________

Zip Code: _______________________Country: _________________________________

Date of Birth: _____________________________________

Telephone: _______________________________________________

Fax Number: _____________________________________________

E-Mail: __________________________________________________