Book and Video Order Form
Name:
Billing Address (for credit cards if different than mailing address): City State Zip Code
Phone: Email:
Pay by Check or Credit Card
Credit Card Type Visa Master Card Discover American Express Credit Card Number Exp. Date Security Code: 3 digits on back of card or 4 digits on front of American Express.
Each book is signed by the author and Standard Shipping is included
KY Residents add 6 % sales tax
Grand Total
Make checks payable to Kelly Mehler, LLC. Email, or print and either fax or mail this form after filling out. Feel free to call (859)986-5540 or email kelly@kellymehler.com with questions. Fax: (859) 986-1233 Mailing Address: Kelly Mehler P.O. Box 786, Berea, KY 40403.
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