Please print, fill out and send with a cheque made payable to "Sam Cowan" to:

Sam Cowan, Flat A, 25 Collingham Gardens, London, SW5 0HN (UK)

Remember to enclose your completed questionnaire if you are ordering a bath blend. Postage and packing have been calculated into all the costs below. The book is the only product available for international delivery. Sam can accept cheques for the book in both pounds and US dollars. Please note that purchases are non-refundable.

Name:	__________________________________________________________________________________
Mailing address:	__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Tel no:	__________________________________________________________________________________
E-mail:	__________________________________________________________________________________

ITEM	PRICE	QUANTITY	TOTAL
Toner	£9.50
Hand cream	£10
Foot cream	£10.50
Book (please specify which one)	£10.50
Book " " (US delivery)	US $25
Book " " (rest of world)	£12.50
Bath blend *	£39.95
Bath blend gift voucher *	£39.95
Complementary therapy voucher **
Consultation + 45 min treatment	£60
Consultation + 60 min treatment	£75
Consultation + 75 min treatment	£90
Baby massage lesson voucher	£85
Miscellaneous
		OVERALL TOTAL: