Quit Smoking Products
Post Order Form

FILL IN the relevant details on screen. Then PRINT OUT
Phone your order to:	Post your order to:
+64 4 389 9123 Credit card details are required	Quit Smoking Guide PO Box 25-369 Wellington 6146 New Zealand Payment is required with your order.

First Name:

Last Name:

Address:

Country:

Phone:

Fax:

E-mail address:

Quit for Good Course CDs .. .. .. .. .. .. .. .. .. .. .. .. .. US$49.95

Quit for Good Course - MP3 audio download .. .. .. .. US$49.95

Please email us for prices in your country's currency

Payment Type:

VISA Master Card Cheque (Mail only) Money Order (Mail only)

Card Holder's Name:

Credit Card No:

3 Digit Security No:

Expiry Date:

Card Holder's Signature: