Keep It Simple Order Form
This order form can be faxed to 209-728-0861, or mailed to: Keep It Simple, P.O. Box 1979, Murphys, CA 95247. Keep It Simple can be reached at 209-728-0859

 

Name _____________

Address: ___________

City _______________

State ______ ZIP code _______

Country ___________

Phone number ______

Email address _______

  

How did you hear about us?

__Friend or Relative
__Public Talk Book
__CD, tape or other product
__Internet
__School/Teacher
__Therapist
__Other______________________
 
ITEM# Quantity Description Size Total
         
         
         
         
         
   
Subtotal
  
   
CA add 7.25% tax
  
Shipping & handling (There is minimum shipping and handling fee of $5 on all orders.)
  
TOTAL
  

Method of Payment:
__ Check (Make checks payable to Keep It Simple)
__ Credit Card

Card number _______________________________

Expiration Date _____________________________

Name on Card ______________________________