To order Power to Choose—Challenge to Change, please use the form below. You can either complete the form on-line and send your credit card details via e-mail, or you can print out the form and return it via fax or mail to the address shown at the bottom of the form. If you mail the form, you may pay by company cheque, bank cheque or Australia Post money order. Make cheques payable to Mark Horton & Associates Pty Ltd.

 

Name
Company
Email
Address
Card Type	Visa  Bankcard Master Card American Express
Card Number
Name on Card
Expiry Date	Choose Expiry Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Choose Expiry Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number of Copies
Total @ $20 / Book *	$
Shipping @ $5 / Book *	$
Total Cost	$
Please charge my card the amount shown above, Signed * *
Date * *
Comments
Clicking the submit button sends your registration to a secure site. After the information is submitted, you will be redirected to the main Mark Horton home page which is not a secure site. ALL OF YOUR INFORMATION WILL BE TRANSMITTED VIA THE SECURE HTTPS PROTOCOL.

* Price includes GST
* * Used when sent by mail or fax

Notes

1. Please allow 21 days for shipping and handling
2. Cheques should be made payable to Mark Horton & Associates Pty Ltd
3. Quantity Orders are invited. For bulk discounts, please telephone.