Order Form for Purchases from Dr. Darryl Pokea

To order a CD, print this form using the print menu
from your browser, fill it out, and send it to:

Dr. Darryl Pokea (Attn. Sales)
10288 Stallion,
Topeka, KS  66615-9118


When finished printing, please click the
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Name:
 
Street:
 
City:
 		 State:
 		 Zip:
 
Email:
(optional)
Item Qty Price
Awaken the Senses, Heal the Cells     @  $12.95
    
Relax from Head to Toe     @  $12.95
    
Subtotal:  
Tax: (Only for Kansas residents; add $ .97 for each CD) *    
Shipping and Handling: $5.00 (For up to 4 CDs)  (For 5 CDs or more, add $10.00 for shipping)    
Total:  

Note:
  • No sales tax except for Kansas residents.
  • All US & Canadian orders shipped US Mail within two days.
  • International orders, email us for a quote for shipping.
  • Cashier check, money order, or personal check accepted.
  • Allow one week for personal check to clear.
  • * Tax will be adjusted for each locality in Kansas.
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