Please Print out and FAX TO: 01-866-587-5855

PURCHASE ORDER # B-

From: __________________________________

__________________________________

Contact Phone #: ________________________

(Include country code)

QuantityItem Description PriceTotal

_______|___________________________________________|______________|_______________

Total of All Orders ________________

Shipping/Handling ________________

UPS Acct.#__________________

TOTAL: ________________

Only Payments Accepted:

Wire Transfer

Letter of Credit (with approval)

Limited C-Card