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Order Form
To order a copy (or copies) of this book, please complete this order form, enclose your payment, and send to:

Natural Hormone Clinic
Corinth Square Professional Building
3700 West 83rd Street, Suite 202
Prairie Village, Kansas 66208


Name: ________________________________________
Street Address: _________________________________
Address (cont.): ________________________________
City: __________________________________________
State/Province: ___________ Zip/Postal Code: ________
Country: ______________________________________
Day Phone: ____________________________________
Evening Phone: _________________________________

Billing Information:

Quantity:	_____
The Little Hormone Book ( $18.74 x Quantity ):	$_____
Shipping/Handling ($4.50 in USA, $7.00 outside of USA):	$_____
Sales Tax (Kansas residents only add $1.26):	$_____
Total:	$_____

	Check or Money Order Enclosed
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Name (as it appears on card): ____________________
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Expiration Date: _________ / _________
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Please allow 2-4 weeks for delivery.