DreaMirror©
Electronic &/or Print-Out Dream Submission & Order Page
If paying by credit card complete, printout and send this form using the Submit Button .

If paying with check or money order Print out this page and send to:
Marlene King PO Box 477, Murphy. OR 97533



Send one significant dream and I'll send you an in-depth personal response
along with your own DreaMirror and instructions for use.

Dream Consultation & DreaMirror©$40.00

Please Enter Your Dream Here  then return to this page and complete personal & payment information.

    YOUR FULL NAME
    ADDRESS
    CITY
    STATE
    ZIP
    HOME PHONE
    Email Address
 

TOTAL AMOUNT OF ORDER

If paying by credit card:

Credit Card: Visa Master Charge American Express
Card Holder's Name
Phone Number

Credit Card #

Expiration Date

If you wish to Pay-by-Check online, 'Submit, press your 'Back' button and  click here.
If paying with check or money order Print out this form and send, along with payment to:

Marlene King PO Box 477, Murphy. OR 97533
If you wish to write me for more information, click here.