Playground Boot Camp Product Order Form

Please read the Policies & Procedures prior to ordering

(If you are unable to print using this button, print from your web browser's print option.)

Follow the instructions on the form and mail or fax to the address listed below.

Mailing Address:
John Spencer Ellis Enterprises, Inc.
c/o Playground Boot Camp Order
30245 Tomas
Rancho Santa Margarita, CA 92688-2123 USA

Fax Number:
(949) 589-8216

Please print clearly or type.

No personal checks are accepted. We do accept all major credit cards, company checks, money orders and bank checks.

Bill To:

First / Last Name:
Company:
Address:
City:		State:
ZIP:		Country:
Phone:		E-mail:
Fax:

How did you find us on the Internet? (Yahoo, Exite, Info Seek, Web Crawler, etc.)
What was your search word(s)? ___________________________________________

Ship To: (If different from 'Bill To' or Gift for Another Person)

First / Last Name:
Company:
Address:
City:		State:
ZIP:		Country:
Phone:		E-mail:
Fax:

All P.O Box and Military Base address will be shipped via US Priority Mail.

Playground Boot Camp DVD featuring John Spencer Ellis	Quanity:	Cost:

Sub-Total:
Shipping Charges (see below):
(No taxes - We cover any applicable taxes) Grand Total:

Shipping Charges

Shipping Method	Cost:
U.S. FREE Shipping (within the Continental U.S.)	$0.00
Military Addresses	$0.00
U.S. Hawaii, Alaska, Puerto Rico	$10.00
Canada Standard	$10.00
Int'l Standard (Estimated shipping cost. Additional fees may apply.)	$20.00

Credit Card, Bank Check and Money Order Payment:
Credit card, Debit Card, Bank Check, Money Order, U.S. funds only

Payment Information: Credit Card:
(circle option)

Visa or MasterCard or AMEX or Discover Card

Other Payment: (circle option)

Cashier's Check or Money Order

Make payable to: NESTA

Name on the Card:
Credit Card Number:
Card Expiration Date:
CVC Code*
Your Signature:

*Visa and Mastercard
In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.

American Express
On the front of your card next to your main credit card number look for a 4 digit code. This 4 digit number is the Card Security Code.