ORDER FORM
Mail / Fax Completed Order Form to or Call Toll Free (800) 242-4418
815 South Central Ave., Suite 4, Glendale, CA 91204, USA
Phone (818) 241-1050 Fax (818) 241-1575

HOW TO ORDER

Fill in the following form and push the SEND ORDER button at the end of the form to send your order electronically. -Or you may Download/Print this form onto your computer, complete the information and mail or fax it to us.

CARTOUCHE ORDERS

Name Item#SizeStylePriceTot. Amt

OTHER MERCHENDISE ORDERS

Item#ColorQTYDescriptionWeightPriceTot. Amt

Shipping and Handling Charges
All jewelry, Cartouche, Papyrus, & single piece Bottles @ $5.50
CA residents add 8.25% Sales Tax
Shipping Handling (See Table)
Heavier Merchendise will be charged by weight.
Grand Total -----

Buyer's Info, (Please no P.O.Box for shipping address):

Name Add1 Add2

City State Zip Country Tel

Alternative Shipping, (Please no P.O.Box for shipping address):

Name Add1 Add2

City State Zip Country Tel

Method of Payment: Check or Money Order is enclosed for $

We also accept VISA or MASTER CARD

Card Number Expiration Date

Exact Name on Card Signature

After completing the form, simply push to send your order or to re-enter the info.

SATISFACTION GUARANTEED

Sould any item you order not meet your expectations, it may be returned within 30 days for replacement or refund. Personalized cartouches, only if defective, will be replaced.