Contact Information

To Pay by check or Money Order

Please make payable to Howard Johannesson, PHD and mail to:

Hypnosis Rx
Howard Johannesson PHD
14295 Dogwood Ln.
Belle Haven VA, 23306-1624

Include Program number, name and the quantity you order.

ORDER FORM

CHECK OR MONEY ORDER

Name ______________________________________________________

Address ____________________________________________________

City __________________________ State __________ Zip __________

Outside USA

Address ________________________ Area/State___________________

Country _______________________ Zip/Zone etc. __________________

 Item # ______ Title _____________ Quantity ______ Price __________

 Item # ______ Title _____________  Quantity ______ Price __________

 Item # ______ Title _____________ Quantity ______ Price __________

                                        (Free shipping in USA)    Total Price _________

                                       Outside USA add $5.00 for Shipping __________

                                                         Outside USA Total Price __________

 (must enter) *e-mail address ___________________________________

(must enter)  * Phone number ___________________________________

Only Bank America or American Express checks Outside USA

Payable in USA $$ only

Highlight (select this page) - print or highlight this order section - copy - open notebook - paste - print

Shipment on bank checks within 24 hrs. (excluding weekends).  Personal checks will take 5 working days from the time we receive your order; allowing for check to clear your bank.