Healthy Relationships Order Form

NEW If you wish pay by credit card (in US dollars) online via secure server, you can do so now through our e-commerce supplier Regsoft.com. Follow this link for easy ordering instructions.

Use the following form for payment by check or money order, or with a signed purchase order.

Three easy steps: 1. Fill in the order form. 2. Print this page. 3. Fax or mail in your order.

Shipping charges are included in all Canada/US orders.

Payment or a signed purchase order must be received prior to shipment.

Fax (with purchase order) to: (902) 457-4597

Mail (with purchase order or payment) to:
Men For Change
Quinpool PO 33005
Halifax, Nova Scotia
Canada B3L 4T6


Number of 3-volume Sets:	@ $70.CDN/$70.US =
	Total
Method of Payment:	Check Money Order Purchase Order #
	Payable to: MEN FOR CHANGE
Name:
Organization:
Street:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone:
Fax:
E-mail:

Need help?
For assistance or for more information about Healthy Relationships curriculum call (902) 457-4351 or e-mail: hrc@m4c.ns.ca

Ordering from outside Canada/US? Contact us for a quote on shipping charges before ordering hrc@m4c.ns.ca

Thank you for your order!