Attachment Disorder Treatment

attachment and bonding center of ohio

gregory c. keck phd

PRINTABLE ORDER FORM
Please complete this form and return with credit card information or check payable to: Attachment and Bonding Center of Ohio, 12608 State Road, Suite 1, Cleveland, OH 44133. If any questions, please contact Arleta James at 440.230.1960, ext. 4 or Arletaj@aol.com.

COST: $725.00. Ohio purchasers pay $783.00 which includes tax.

Purchase price includes shipping and handling in the continental United States*.
Discounts are available on multiple purchases - please call 440.230.1960, ext. 4 or email Arletaj@aol.com to obtain this information.

NAME____________________________________________________________________________

AGENCY__________________________________________________________________________

ADDRESS_________________________________________________________________________

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STATE_______________ ZIP CODE__________________________
(or province) (or postal code)

COUNTRY__________________________________________________

PHONE ( )__________________________________________

_____ Master Card or _____ Visa

Credit Card #_______________________________________________________________________

Expiration Date_____________________________________________________________________

Cardholder Signature_________________________________________________________________

*All shipping is via priority mail. Please allow 14-21 days for delivery within the continental United States. For orders in Hawaii, Alaska, or other countries, please contact the Attachment and Bonding Center for shipping price and arrival time.

Gregory Keck, Ph.D.

Attachment and Bonding Center of Ohio
12608 State Road
Suite 1
Cleveland, Ohio 44133
Cleveland Office 440-230-1960
Columbus Office 614-261-8800