Please print this form, fill it out and sent it with a signed Check or Money Order to
Kin H Chan
565 80th street apt 3F
Brooklyn N.Y. 11209
Video Product / Classes  / On line Video Clips Description
Quantity
Price $$
     
     
     
     
     
     
     
  Shipping
 
Total $$
 
Name
___________________________________________________


Address
___________________________________________________

City                                 State
___________________________________________________
Zip Code       E-mail Address
___________________________________________________

Phone #
___________________________________________________

Make all Checks or money order payable to

Kin H Chan
565 80th Street apt 3F
Brooklyn N.Y. 11209

Shipping
Please use our shipping rate

All video will take 6 to 7 business day after
receiving payment. Thank you. Feel Free to
Contract me at info@thehypno.com
Back to U.E.P