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Name: ______________________________________________

Street Address: _______________________________________

City: _______________________________________________

State: ______________________________________________

Country: ____________________________________________

Zip Code: ___________________________________________

Phone (optional): _____________________________________

E-mail (optional): _____________________________________

METHOD OF PAYMENT:

Check ____ Money Order ____ Credit Card ____

CREDIT CARDS:

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Card Number: _______________________________________

Expiration Date: ______________________

Signature of Card Holder: ______________________________

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MAKE CHECKS PAYABLE TO:

A Counseling Center, P.C.

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MAIL TO Address Below -- OR FAX TO -- 402-573-7360

A Counseling Center, P.C.

3323 North 109th Plaza

Omaha, NE 68164-2908

ITEM	QUANTITY	PRICE	Total Price
BOOKS
Discover Patterns Dominate		$19.95
Code of Shit		$9.95
Beyond Thought		$14.95
Planet Earth Insane		$19.95
We're All Insane!		$9.95
Stress For Success!	sold out	$14.95	SOLD OUT
Self-Concept: Enemy	sold out	$4.95	SOLD OUT
Attitude is All You	sold out	$19.95	SOLD OUT
The Seventh Way	sold out	$14.95	SOLD OUT
The Secret of Maturity	sold out	$4.95	SOLD OUT
ALL 5 Books Discount: special $7 shipping	($7.00)	$64.95	Save $9.80!
Guide to Rational		$14.95
You Can Control		$19.95
Green Tea
1 Box 100 Tea Bags		$5.95
3 boxes 300 bags counts 3 items	(3)	$15.95
NOW CALCULATE YOUR ORDER
TOTAL MERCHANDISE PRICE: Sub Total			A
Nebraska resident tax:total price or A x 0.07 =B			B
TOTAL QUANTITY of Items Ordered
USA SHIPPING & HANDLING: $3.95 first plus $2.00 each additional			C
GRAND TOTAL = A + B + C

** Please mail all pages along with your check or money order. Thank you!

**International orders (outside USA) please e-mail for shipping costs. Thank you!