Print
and Mail/Fax Order
Form
Please print this form in landscape orientation for best printing results.
Fax your order to (717) 238-5147 or mail your order to the address shown on the order form below.
If you have any questions, or would like to place your order by phone, call (717) 763-1798.
Name
Company
Address
(No P.O. boxes please)
City
State
Zip
Phone(
)
Fax( )
E-mail
Address: __________________________________________________________
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Quantity |
Item
Number/Description/T-Shirt Size and Slogan |
Unit
Price |
Total |
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Mail orders: Check money orders (Payable
to Health Program Planning, Inc.) |
Mail Orders: Check/Money Orders (Payable to H |
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Tax: 6% for PA Residents |
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Health Program Planning, Inc. |
Shipping: |
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1017 Mumma Road, Suite 200 |
$3.00 per book |
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Wormleysburg, PA 17043 |
$2.00 per refill |
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TOTAL |
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Web
Orders: www.healthprogramplanning.com
o
Visa
o MasterCard
Check No.
Amt. Enclosed
Card
No. | |
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Exp. Date
/
mm
yr
Cardholder
name
Reorder Items: Please
allow 4 weeks for delivery.
TSHIRT1: "My mom is a dietitian...and I am a nutrition tidbit."
Children's Sizes: 2-4 6-8 $14.00
Sorry, size 2-4 of "My mom" t-shirts are
TSHIRT2: "My grandma is a dietitian...and I am a nutrition tidbit."
Children's Sizes: 2-4 6-8 $14.00
TSHIRT3: "My aunt loves to feed me...and I am a nutrition tidbit."
Children's Sizes: 2-4 6-8 $14.00
Sorry, both sizes of "My aunt" t-shirts are
TSHIRT4: "I am a nutrition tidbit."
Children's Sizes: 2-4 6-8 $14.00
TIDBITS:
Dr. Irene's Nutrition Tidbits
Tidbits Book/T-Shirt Combo Pack (taxable) $22.00
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PHR1:
Personal Health Record -Executive
Burgundy $45.00
PHR2:
Personal Health Record-Executive Almond
$45.00 Sorry, the Personal Health Record Binder is
Personal Health Record Refills: PHR3:
Health Summary Tablet
$8.00 PHRs1:
Section 1
$6.00 PHRs2:
Section 2
$6.00 PHRs3:
Section 3
$6.00 PHRs4:
Section 4
$6.00 PHRs5:
Section 5
$6.00 PHRs6:
Section 6
$6.00 PHRs7:
Section 7
$8.00 PHRs8:
Section 8
$8.00 PHRs9:
Section 9
$6.00 PHRs10: Section 10 $6.00
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