Quit Joking & Stop Smoking: The I'VE QUIT Process Order Form
Please print this order form and fill it out completely.

Mail Orders: Mail completed order form with your check or money order for $14.95 in US funds to the following address. Make check payable to "Walt Capell".

Walt Capell
3000 Alsup Drive

Columbia, MO  65203

Please print all information clearly.

Name: _____________________________________________________

Email Address: ______________________________________________

Street Address: ______________________________________________

City: _____________________ State/Province: ____________________

ZIP/Postal Code: ______________ Country: ______________________

_____________________________________________________________

Your Total Cost is $14.95.  The audio CD, Quit Smoking Agreement, confidential e-mail address and I'VE QUIT card will be shipped immediately upon receipt of your order.  Shipping and handling is FREE to all U.S. destinations!  We also ship to Canada, Mexico and Puerto Rico.  If you live anywhere else in the world, please include an extra $10 (that's $24.95 total) and we'll ship your CD via International air.