QUICK ORDER FORM

Fax Orders:	(413) 637 4036. Print & send this form.
Telephone Orders:	(413) 637- 4036
Email Orders:	agesmart@agesmart.us
Online Orders:	www.agesmart.us Print and mail this form.
Postal Orders:	Age Smart
	Dr. Harriet Vines
	PO Box 561
	Lenox, MA 01240
	USA

Please send ____copy/ies Age Smart $13.95 = $_______

Please send FREE information on:
___ Speaking/Seminars ___ Consulting

Name:_________________________________________

Address: _______________________________________

City: _______________________________State: ______

Zip: ________Telephone: _________________________

Email address: __________________________________

Sales tax: Please add 5.0% for products shipped to a Massachusetts address.

Shipping by air: U.S.: $4.00 for first item and $2.00 for each additional product.
International: $9.00 for first item; $5.00 for each additional product (estimate).

Total Enclosed $_______ Payment by check or money order only.

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