~ Robinn Lange ~
Printable Order Form
Please make your check or money order payable to and mail this form to:

LangePro
P.O. Box 110
Warrenville, Illinois 60555

Item Description - Color / Size

Quantity Price Each Extended Total

Live Show DVD

Please give us the LOCATION, DATE & TIME
of the show you are ordering

  $ 25.00  
COMPLETE Stop Smoking Program   $ 125.00  

Hypnosis Show T-Shirt
Circle Size- M L XL XXL

         $ 25.00        
Hypnosis Exposed Book   $ 25.00  

Entertainment Career Directory

   $ 40.00  

Cassette Tapes (Circle Titles Wanted)
Stop Smoking
Weight Loss
Self-Hypnosis
Improved Academics
Improved Athletics
Relaxation & Better Sleep

   $ 20.00
each		  

CDs (Circle Titles Wanted)
Stop Smoking
Weight Loss
Self-Hypnosis
Improved Academics
Improved Athletics
Relaxation & Better Sleep

         $ 25.00
each 		       
Complete set on Cassette         $ 100.00        
Complete set on CD         $ 125.00        
Autographed Sparkle Photo         $ 3.00        
Autographed Spiral Photo         $ 3.00        

Shipping Charge
Please add the following....
From: 3.00 - $49.99 (add $5.00)
From: 50.00 - $99.99 (add $7.50)
From: 100.00 - $199.99 (add $10.00)
Over: $200.00 (add $20.00)

      

GRAND TOTAL ~
                         

SHIP TO ADDRESS:
Name ___________________________________________
           (First, Last, M.I.)
          ___________________________________________
           ( Street or P.O. Box )
           ___________________________________________
           ( City, State, Zip )
            ___________________________________________
           ( Daytime Telephone Number )
            ___________________________________________
           ( E-Mail Address )

Please allow 3-4 weeks for delivery.