Book Order Form

DOUGLAS BLOCH, M.A.
BOOK ORDER FORM

Print this order form and mail it with your check or money order
to Douglas Bloch at the address listed on the order form. Thank you.

Name ________________________________________________________________

Mailing Address ________________________________________________________

City, State, Zip_ _________________________________________________________

Telephone ____________________________Email ____________________________

PRINTED BOOKS

Healing From Depression # Requested ___ X $19.95/copy = book cost       ____________

Words That Heal # Requested ___ X $12.95/copy = book cost                       ____________

Listening To Your Inner Voice # Requested ___ X $11.95/copy = book cost      ____________

I Am With You Always # Requested ___ X $12.95/copy = book cost                   ____________

Positive Self-Talk For Children # Requested ___ X $16.95/copy = book cost   ____________

Postage ($4.50 for the first item; $2.00 for each additional)                            ____________

EBOOKS (ELECTRONIC)

Beyond Prozac ___    $24.95                                                                               ____________

Helping Your Depressed Child ___    $19.95                                                    ____________

Helping Your Depressed Partner ___    $24.95                                                ____________

Helping Your Depressed Friend ___    $24.95                                                 ____________

(No shipping costs on the ebooks)
TOTAL COST ____________

(make check or money order payable to Douglas Bloch)

Please mail the order and payment to:
Douglas Bloch, 4226 NE 23rd Ave. Portland, OR. 97211
(503) 284-2848
Delivery will take 7-10 days.