Order Form  -  Fax or Mail
Fax:  (904) 342-0069   or   Mail: Subliminal Assistance LLC, P.O. Box 600721, Jacksonville, FL  32260-0721
                   
BILL TO:                                   (Please Print)           SHIP TO:                                   (Please Print)            
              (Credit Card orders - Name & Address must match card exactly.)                   (Write SAME, if matches Bill To information.)
Name: ___________________________________ Name: __________________________________
Address: _________________________________   Address: ________________________________
City: ________________ State: ____  Zip: ______   City: ________________ State: ____  Zip: _____
Telephone: ________________________________    Telephone: _______________________________
E-mail: ___________________________________ E-mail: __________________________________
____ Check          ____ Money Order          ____ MasterCard          ____ Visa 
Card # ________________________     Exp. Date ________     Signature ____________________________
 
FORMAT  (check the appropriate box or boxes)
Product # Quantity Cassette CD SC2CA SC2CD Video Spanish French Price Total
                     
                     
                     
                     
                     
                     
   
 
Subtotal  
  Shipping & Handling Charges   (see below)  
6.0% Sales Tax    (Florida Residents Only)  
            Total Transaction Amount  
 
Shipping & Handling Charges PRICING Stock Items Special Order
  Up to $19.99   $5.00 Cassette $19.98 $19.98
  $20.00 - $59.99   $6.50 Compact Disc $23.98 $23.98
  $60.00 - $99.99   $8.50 SC2 - Cassette $23.98 $23.98
  $100.00 - $199.99   $12.00 SC2 - CD $31.98 $31.98
  $200.00 - $299.99   $15.00 Video $26.98 $26.98
  $300.00 - Greater   $20.00
  Canada - add   $7.00 •  All products are guaranteed against material defects for one year from the
  2-Day - add   $12.00   date of purchase.  If a defect does occur, please return product - along with
  3-day add   $6.00    original invoice - for replacement or credit - less S&H charges.
Please call for rates on overnight • All returns must have an RGA (Return Goods Authorization) number to 
   and international orders.   receive credit.  An RGA number can be obtained via e-mail request.
• All returns must be accompanied by original invoice and printed material(s).
Consumer Notice:  All of our products are sold as educational and training self-help tools.  No medical benefits are claimed or implied and do 
                                   claimed or implied and do not substitute for proper healthcare.  Our pricing and shipping charges are subject to change. 
                                   We retain the right to refuse to do business with anyone, at anytime and for any reason.