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 Summary Videotape

Order Form for Canada
(Click here for PAL formats)
(Click here for orders in the USA)

Fill out this form and mail with your payment to :

The Healthy Self Inc.
2308 Des Grisons
Laval, Quebec
Canada, H7M 5Y7
First name:
Last name:
Address:
City: State or Province*:
Country: Zip or Postal code*:
Home phone.: Work phone:
Fax: E-mail:

Quantity :
Total amount of your order :
( Click here to see our price list )
Type of payment (payable to : The Healthy Self Inc.) ** :
Check
Money order
Signature: Date:

* If applicable

** Why did we choose not to use credit cards?
User fees for payment by credit card would cause an increase in the videotape sale price.