Doc Bear Handout Order Form

Your FULL name:
[required]

Street Addres
City, State, ZIP CODE): s
[required]

Home Phone:
[required]

Visa or MasterCard # with Expiration Date-Warning: This is a non-secured site. Call if you prefer.
[required]

E-mail address:
[required - for confirmation]

Which PreK through Grade 3
Doc Bear Adventure Story do you wish to order?
Each Story: $5
(not reproducable)
All Lessons in Part 1: $25
All Lessons in Part 2: $25
Buy ONE Entire Collection: $40 in Reader Format.
Buy more than 20 Readers (Entire Collection): $12 each!

Select one item per line.

I would like to get a copy of what would be sent to the Doc Bear Associate.

Please provide the following additional information:
1. Total of your order
2. Add 8.75% sales tax to total if your order is going to a Louisiana address.
3. Add 10% for shipping (USPS Priority Mail Only), and handling
4. DAY TELEPHONE NUMBER.
Thank you for your order!

Warning: This is a non-secured site. You charge will show up as "World Academy of Martial Arts/Karate Supply Shack"

By selecting the SUBMIT Button below, you are agreeing to the following conditions:

I hereby submit my order for Doc Bear Materials. I agree NOT to duplicate stories and purchase as many as I need for each student. Life&Health Enahncement Services and/or Michael Pejsach ("Store") are not liable for any errors in your order, or any issue related to incorrect orders, late delivery of orders or any such matter. The applicant ("Applicant"), whose full name appears above, hereby stipulates that he/she is over age 18. Applicant hereby also verifies that the credit card information is in his/her name and is accurate to the best of his/her knowledge. Applicant hereby waives, releases, and forever discharge the Store, and all participants, on behalf of Applicant, his/her heirs, his/her executors, his/her administrators and assigns, of any and all claims, rights, or causes of action whatsoever for any errors, damages or injuries which may arise as a result of this order. Applicant hereby waives and forever holds blameless, for any consequence as a result of this order, or which might arise thereafter, against any person or entity in any way connected with the Store. The Applicant indemnifies and release all members of Store from all claims made or which may be made on behalf of the applicant, for the aforesaid consideration. Applicant understands that prices are subject to change without notice. Applicant agrees to take responsibility for his/her order errors and pay for return shipping if necessary.

Thank you for your order! For more information, call us @ (---) ===-====.
Fully operational store coming soon!

Your FULL name:	[required]
Street Addres City, State, ZIP CODE): s	[required]
Home Phone:	[required]
Visa or MasterCard # with Expiration Date-*Warning: This is a non-secured site. Call if you prefer.*	[required]
E-mail address:	[required - for confirmation]
Which PreK through Grade 3 Doc Bear Adventure Story do you wish to order? Each Story: $5 (not reproducable) All Lessons in Part 1: $25 All Lessons in Part 2: $25 Buy ONE Entire Collection: $40 in Reader Format. Buy more than 20 Readers (Entire Collection): $12 each! Select one item per line.