Home
Child Sexual Abuse Prevention
Education versus Prevention
Empowering Children
Start Talking
Ask answer and listen
Keep Talking
Thank You
Education About Abuse & Safety
What to talk about
Educational Materials
Lets Talk Book Information
Ordering Information
Getting Help
When you suspect abuse
Mission Statement
About Dr Stauffer and Hope
|
| If ordering by credit card, you may fax your order. To order by check or money order, please mail your order. |
Print this form and fax it to
215-362-7373. |
Name: ______________________________
Agency Name:___________________________
Address: ____________________________
____________________________________
Phone:__________________________
E-Mail:_________________________
Quantity of Let's Talk...for Young Children: ______________
Total price of young children's books at $10 per book: ______________
Quantity of Let's Talk .. About Body Safety (elementary): _______________
Total price of elementary books(@$15 per book):______________
Quantity of elementary age workbooks :__________________
Total Price of Let's Talk..Workbook About Taking Care of Me(@$8 per book):______________________
Total Price of 5-pack Safety Skill activity books (@$10 per pack):______________________
Total price of 100-pack Safety Skill activity books (@ $150per pack):_________________________
Total Price of Books: _______________
(PA ONLY)Sales tax: ______________
(Add 6% tax for PA residents;
Phila & Pitts residents add 7%)
Shipping & Handling: _____________
($7 for up $20, $12 for $21-120, over $120 add 10%; add $10 extra for international delivery up to $100, over $100 add an additional 10%)
Total price of order: ______________
|
| FOR CREDIT CARD ORDERS, COMPLETE THE FOLLOWING INFORMATION |
Circle card type:
MASTERCARD VISA AMERICAN EXPRESS |
Name on Card:______________________________________
Address of Account Holder (if different than above):
____________________________________________
____________________________________________
Account Number _____________________________
Expiration Date ______________
Authorizing Signature __________________________________
By signing, you are giving permission for this amount to be charged to your credit card. |
|
|