ORDER FORM
	To Order: please print, then mail to: Impact Therapy Associates 457 Broadway Avenue Star City, WV 26505

Name
Address
City	State	Zip
Phone

Quantity	Books	Price	Amount
	Group Counseling	$85
	Creative Counseling Techniques	$27
	Impact Therapy	$27
	All three books	$135
Quantity	CD’s	Price	Amount
	Group Counseling	$10
	Creative Counseling	$10
	Impact Therapy	$10
	Rapport: Beyond Listening	$10
	Counseling Contract	$10
	All five CD’	$45
	Three books and five CD’s	$175
	Children Deck of Cards	$15
	Adult Deck of Cards	$15
	Road Signs	$10
	Subtotal
	West Virginia Residents Add 6% Sales Tax
	Shipping One, two, or three items; add $6 Four to eight items; add $10 Nine items or more; add $15
	Grand Total
	Make checks payable to: Dr. Ed Jacobs

BOOKS | AUDIO TAPES