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** **Order Form** ** Order Form** **Order Form ** **
Burning Bush Solutions order form.
Instructions:
(1.) Print this page using your browser "file" menu bar.
(2.) Put an "x" or a number next to the package(s) you are ordering.
(3.) Completely fill out the form then sign.
(4.) Then mail your order to:
Burning Bush Solutions
Josephstraat 1B
3014 TE Rotterdam
The Netherlands
Your orders will only be processed upon receipt of cash payment.
ORDER 3 SHORT STORIES VIA E-MAIL AND GET THE FOURTH ONE
FREE !!!!
[ ] YOU GET "Fall from Grace" -- for.....$2.45 US$
[ ] YOU GET "Lobotomy Labs" -- for.....$2.45 US$
[ ] YOU GET "The Wilderness" -- for.....$2.45 US$
[ ] COPY(S) OF "Black Fathers, White Fathers" (paperback) -- for.....$6.95 US$
[ ] COPY(S) "Black Fathers, White Fathers" (hardcover) -- for.....$12.95 US$
[ ] COPY(S) "The Africa a Black Soul Deserves" (paperback) -- for.....$24.95 US$
All orders; domestic and international are sent to your e-mail, or, in case
you order the
paperback or hardcover format of the books, are sent from the Netherlands. Shipping
costs are handled
on a regional, and quantity basis. You will be informed of these costs
by your local post office upon receipt of your order.
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YOU ARE ASSURED 100% Satisfaction Guaranteed!!!
Order TODAY to Guarantee items available!!!
RUSH ORDER telephone line: 0031627103388
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TODAY'S DATE________/___________/___________/ (DD/MM/YYYY)
AUTH: RV
NAME____________________________________________
ADDRESS________________________________________
CITY, STATE, ZIP___________________________________
PHONE NUMBER ( ) ______________________
TO ENSURE ACCURACY, PLEASE TYPE OR CLEARLY SPELL
YOUR EMAIL ADDRESS: _______________________________
TYPE OF CREDIT CARD:
_____VISA _____MASTERCARD _____DISCOVER______AMEX
CREDIT CARD# ________-________-________-__________
EXPIRATION DATE______/________ (MM/YYYY)
NAME ON CARD____________________________________
TOTAL AMOUNT $____________________
(Required)
AUTHORIZATION SIGNATURE:______________________
CHECK ORDERS ACCEPTED. SIMPLY FILL OUT THE CHECK AND
TAPE IT
TO THE BOTTOM OF THIS ORDER FORM AND SEND IT TO:
Burning Bush Solutions
Josephstraat 1B
3014 TE Rotterdam
The Netherlands
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****TAPE CHECKS BELOW THIS LINE****
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Use the method below if you cannot use the methods above.
(5.) Send informaton of the article(s) you want to: order@mukazo.com
(6) Make your payment via the Union Bank to the above address.
Your orders will only be processed upon receipt of cash payment.
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