Books and Video order form < East Side Institute for Group and Short Term Psychotherapy

East Side Institute Book/Video Order

Order by telephone: (212) 941-8906

Or print this form and return with your payment:
by fax: (212) 941-0511, Attn: Melissa Meyer

by mail:
East Side Institute
920 Broadway, 14th Floor
New York, New York 10010

Please allow two weeks shipping time.

Name	______________________________________________
Address	______________________________________________
	______________________________________________
City	______________________________________________
State	_________________ Zip Code ___________________
Phone	_____________________ E-mail __________________

Qty	$ Amt	Title	Price
______	$________	___________________________________________	$_______
______	$________	___________________________________________	$_______
______	$________	___________________________________________	$_______
______	$________	___________________________________________	$_______
______	$________	___________________________________________	$_______
	Shipping		$_______
	Add $3 shipping and handling for one book or video; plus $1 for each additional. For international shipments add $5.
	Tax		$_______
	NY state residents should add 8.25% sales tax.
	For videos indicate ______ VHS _____ PAL.
Grand Total			$_______
____	I enclose a check/money order for $_____ payable to East Side Institute.
____	Please charge my ___ VISA ___ Mastercard ___ American Express
	Card Number ____________________________________ Exp Date __________
	Signature ____________________________________

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