Fill out this order form, print, and mail it with a check or money order (US dollars)

payable to:

Darkbirthright.com

PO Box 727

East Amherst, NY 14051-0727

          Name    ________________________________________

          Address _______________________________________

          City______________________   State/Prov. _____  Zip/Postal code ___________

          Country _____________________________

          Email address (optional) ________________________________

          Notes ______________________________________________

          How did you hear about the book? ______________________________________

          # of books _____  x  $12  =     _______

          Shipping to USA via USPS media mail = FREE 

          Shipping to non-USA destinations $11 per book  _______

          New York State residents add 8.75% tax or $1.05 per book  _______

          Total:  ________