IJustWantToSleep® Order
Print this and fill it out. Send it to the address or fax number below.

Please check next to package requested:

___ Package "B": Workbook + DVD by Mail ($89.97)
___ Package "C": Kids Workbook + DVD by Mail ($89.97)
*North Carolina Residents add 7% sales tax.

You will receive order confirmation by email if available. Please print clearly.

First & Last Name: ____________________________________

E-mail Address: _______________________________________

Street Address: _______________________________________

City: _____________________________ State: _____________

Zip/Postal Code: ________________ Country: ______________

Telephone Number: ___________________________________

PAYMENT (please circle one)
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Credit Card Number: __________________________________

Expiration: __________________________________________

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Please FAX or MAIL this form with payment to:

Fax: (828) 665-9155
or
IJustWantToSleep, Inc.
1063 Haywood Road
Asheville, NC 28806