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Scratch and Sniff Proust - Multi-Function Form

You will receive an email verifying your order. * indicates required information.
Select one: REQUIRED:

I am placing a book order I am only inquiring about the book I would like to inquire about having Dr Barry as a guest or speaker Other
First Name / Nombre *
Last Name / pellido *
Address
Telephone *
Company Name (if applicable)
City *
State *
zip code *
E-mail *
Website if applicable
Preferred Payment options: We will send you an email to verify that you placed this order

Visa MasterCard Paypal
Card # ( name must be as entered above)
Name on the Card if different than above
CV Code on the back (3 characters)
Expiration Date:
How Many books are you ordering: - an email will be sent to you to verify your order.

Qty 1 $69.95 + $7 shipping = 76.95 Qty 2 (x 69.95 + $14 shipping) =153.90 Qty 3 (x 69.95+ $21 shipping) =230.85 Qty 4 (x 69.95 + $28 shipping) =307.80 Qty 5 (x 69.95 + $35 shipping) = 384.75 More than 5-
Ship to: REQUIRED: *

All copies to purchasers address above: This is a gift - use the GIFT ADDRESS or SHIP TO address at the bottom of this form.
GIFT ADDRESS / SHIP TO address if different than the purchasers address -ENTER the date you MUST have it if this is a gift- additional shipping charges may apply -IF you want to ship this as a gift please enter the complete NAME / address CITY / STATE/ZIP/ TELE FOR EACH RECIPIENT
Should be Empty:

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Scratch and Sniff Proust - Multi-Function Form