Mail or Fax in your order
(click here to return)		Print out the following order form and either:
		Fax it to: Local: 02-9460-8098 International: 612-9460-8098   Snail mail it to: AffirmWare Pty Ltd Suite 30/116 Shirley Rd Wollstonecraft NSW 2065 Sydney, Australia
Yes, rush me the 7-MP3 audio self-hypnosis package from HypnosisEzy, (a division of AffirmWare Pty Ltd).
Address Details:
First Name:	. _________________________.
Last Name:	. _________________________.
E-mail Address:	. _________________________.
	(double check spelling as this is where your download instructions for the "7-MP3 audio self-hypnosis package" will be sent)
Company: (Optional)	. _________________________
Address:	. _________________________
City:	. _________________________
State:	. _________________________
Zip:	. _________________________
Country:	. _________________________
Phone:	. (___) ____ - ______
( ) I am enclosing a check or money order for $97.00 (USD) for the 7-MP3 audio self-hypnosis package. Please note that we do not accept checks by fax, so if you are paying by check you must mail it in. ( ) I want to charge this purchase to my Credit Card
Credit Card (Check One)
VISA Bank Card Master Card
Credit Card #:	. _________________________.
Expiry Date:	. _________________________.
Name on card:	. _________________________.
Signature:	. _________________________.
Other:
Where did you here about HypnosisEzy	_________________________
	Your credit card will be billed for a total of $97.00 (USD). Installation instructions will be emailed to you once your payment is processed, usually within 24 Hours.
	I authorize AffirmWare Pty Ltd to charge $97.00 (USD) to my credit card for the purchase of the 7-MP3 audio self-hypnosis package.
	Mailing address: Suite 30/116 Shirley Rd Wollstonecraft NSW 2065 Sydney, Australia 612-9460-8098 Contact Detials