Order Form
This form can be completed while you are online and then printed or you can print it out and complete it by hand if you prefer.

Product

Description

Price

Quantity

Total

FREE Sleep Coaching for one week. A 79.95 value.

  Yes I’d like to receive the latest news, updates and offers in the SONNO newsletter A $25.00 value for FREE!

FREE Bonus Offers!

Air parcel 10 - 14 day shipping anywhere in the United States.

Expedited 7 - 10 day shipping anywhere in Canada.

International 10 - 14 day shipping anywhere else in the world.

  Yes I am purchasing a service and shipping does not apply.

 

 

 

Subtotal

 

Ontario residents please add 8% Provincial Sales Tax to the Subtotal (for Products Only).

 

Canadian residents please add 5% Goods and Services Tax to the Subtotal (for Products and Services).

 

 

 

 

Total


Shipping Address

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Address

           

City

 

Province/State

Country

Postal Code/Zip

Phone

 

 

E-mail

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Billing Address

  Check this box if same as shipping address

Name

Address

           

City

 

Province/State

Country

Postal Code/Zip

Phone

 

 

E-mail

Your personal information is 100% PRIVATE and NEVER shared with anyone.


Billing Information

Payment Method:  Mastercard   Visa   American Express
 Cheque or International Money order made payable to Perugini-Marquardt International Inc.
                         

Credit Card #

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Expiration

Signature



Your Comments or Special Instructions
  
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www.SleepandDreams.com
1160 Beaverwood Road, P.O. Box 1518
Ottawa, Ontario, K4M 1A4, Canada
Tel: 613-482-0837       Fax: 613-822-0931
sleepcoach@sleepanddreams.com