Online Order Form
PLEASE NOTE: DUE TO LIMITED SUPPLY, AND COSTS, SOME INTERNATIONAL SHIPPING MAY NOT AVAILABLE.
UdefineU "Foundations of Grace and Elegance" DVD Program
Please be sure to fill in all items in the form.  You may print this form out and send by mail, fax,
or submit online today! If you have any questions, please contact us at 561-687-8455.

Your Name:
Your Email:
Confirm Email:
Primary Phone#: - -   ext.
Alternative Phone#: - -    ext.
Company Name:
Mailing Address Line 1:
Mailing Address Line 2:
City:
State/Prov.:
ZIP/Postal Code:
Payment Enclosed:  Select this box if you will print out this form and mail or fax.
To ensure that we reserve a UdefineU Program for you, please complete & submit your contatct/shipping information - even if mailing or faxing your order.
Charge My Account:    Total $109.94
(Includes $9.95 UPS Standard shipping cost - Continental USA)
Account Number: 
Expiration Date: 
Card Security Code: 
Name on Card: 
Card Billing Address: 
City and State: 
Zip/Postal Code: 
Signature: 
                (required if sending by mail or fax)		 _________________________________________________

Please submit this form online by clicking on the submit button below.
You may print out the completed form and fax it to 561-687-2614. Please be sure to sign the form before you fax it to us.  You may also phone in your credit card account information by calling 561-687-8455 (TO BETTER SERVE YOU, MAY REQUIRE A SCHEDULED TIME).  We will email a confirmation number to you.
Be sure to complete and submit your contatct/shipping information online.

If paying by check, please print out the completed form and send it with the appropriate payment to:
Patricia Stephenson & Associates, Inc.
Jefferson Tower, Suite 501
2425 Presidential Way
West Palm Beach, Florida 33401


Thank you.