Adoption Healing Order Form                       

26 years of helping those whose lives have have been touched by adoption

           If you are paying by Credit Card, the address you give must be the address at which you receive your Credit Card Bill.

   *  = Required              SiteLock
 *  Salutation   Mr.    Mrs.     Ms.         *  First:        *   Last:
 *  Street 1:                  Street 2 :
 * City:    * State/Prov     Zip:     * Country:
 *  Home Tel:      Bus Tel.:    I am:    Adoptee     Natural Parent  Other  
* E-mail:  *     Confirm  E-mail:
*  Quantity of Adoption Healing for Adoptees      Quantity of Adoption Healing for Moms      
     Quantity of Adoption Healing Supplement      
 The price is $23.50 for the adoptee version and $25.50 for the Mom or Supplement versions
 which includes S&H in the United States.       

** Insurance NOT included.   If you purchase two or more versions of Adoption Healing at same time,
    there will be a 20% discount on the price of each book.  (Shipping is included in the discounted price)

                All orders outside the U.S. must be paid in US Dollars

Canadian orders are shipped air post: add $3.50 additional postage for each book for up to 3 books.

Shipping outside of North America by Priorty Mail International Flate Rate: add $8.00 additional postage for 1 book, add $11.00 .for 2 books.  (for more than 2 books, please email us for rate)

      Quantity Discounts Available for all book purchase.

Payment Information          

*Amnt of Payment        * Pay by     Name on Card  
  Card Number    Card Expires       * Security Code  What is the security code?
  Comments      If  Not paying by credit card, enter 00 in the Security Code Box above.
Please press the SUBMIT button below


Signature _______________________________________        Date ________________

You may make your payment by faxing your Name and Credit Card info to: 845-267-2736,
or you may call 845-268-0283 and leave the info on our answering machine, or you may send the payment via US Mail

You must, no matter how you pay, send this form with your signature and date of signing to us by fax or to mail it us at the address below

Adoption Healing, 74 Lakewood Drive  Congers, NY 10920-1710

If paying by check, make the check out to Joe Soll.


   E-mail us at joesoll@adoptionhealing.commailboxFormMail  

Last Updated on April 1, 2011 by Joe Soll                         Copyright 2011 Adoption Healing all rights reserved; logo's and graphics appearing on these pages are trademarks of Adoption Healing and may not be used or reproduced without permission.