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PsychWorks, Inc. ™
Behavioral Healthcare For The 21st Century©

 
  
  
  
  
  
  
  
  
  
 
 

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 Behavioral Health Care For The 21st Century 
 Order Form
 
You may use this form by printing it out on your printer and sending it in with your check or Money Order in U.$. currency to our address or submit the form here for C.O.D. payment. Please include S&H*.  

Florida residents please add 6% sales tax to your total. 


Please provide the following contact information: 

 
First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL
 
Please provide the following ordering information: 
 
QTY DESCRIPTION
 
BILLING
Purchase order #
Account name
 
SHIPPING
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
 
*Shipping & Handling 

      Make checks payable to: PsychWorks, Inc. 

      Shipping and Handling charges are as follows: 

      $5.95 for orders up to $30.00 

      For orders over $30.00,   add 20% of the total purchase price. 
 

Ask us about our Lemonade Therapy 

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Copyright PsychWorks, Inc. 
Last Revised December 26,1997
 
 
 

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email: info@psychworks.net

954.344.2022
954.772-2980Facsimile

PsychWorks, Inc,
10191 W. Sample Road, Suite 207
Coral Springs, Florida 33065 USA

visit our subsidiary company:

A place of information for those in business, benefits brokers,  and other corporate representatives who are interested in behavioral risk management and cost containment.

Featuring a members only secure site for all our EAP employee members.

On the web at:  employee-assistance-programs. net

 Advanced Workplace Solutions

   Advanced Workplace Solutions

a division of  PsychWorks, Inc.

 

 

 

Copyright ©1996-2010  PsychWorks, Inc.  All rights reserved.
Online since: October 1996  Revised: April 06, 2010 12:25 -0400.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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