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Panic Prevention Program
Fax/Mail Credit Card Order Form

(Please print the form first and then fill it out.)
Date:  

YES, I want the Panic Prevention Program on CD

 First Name  
 Last Name  
 Address  
 City  
 Country  
 Postal/Zip Code  
 E-mail address  
Phone
Area code Local phone number
 Card (VISA, MasterCard, AMEX only)  
 Card Number  
 Expiry Date  

In order to purchase the Panic Prevention Program, I hereby authorize Uncommon Knowledge Ltd to bill my credit card, and agree to pay to my credit card company, the amount of UK£12.95 / UK£18.95 (please circle one). I understand that my credit card company will convert this amount to the currency of my own country at prevailing market rates.

Credit card authorization:

Signature

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I understand that you will mail my Program to me when you receive this order.

I understand that I am completely protected by your 90 day money-back guarantee.

Agreed:

Signature

Fax this form to +44 (0)1273 774427 or
mail to:
Uncommon Knowledge Ltd
12 Queen Square
Brighton
UK
BN1 3FD

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