ORDER FORM

FOR FAX OR POSTAL SERVICE

Name

Email address

Postal address number

City

State, Zip Code

Telephone

FAX, if possible

ORDER

List inventory number, item, price

add $10 per item shipping

Credit card information (Visa - Mastercard only):

Namc

Credit card number

Expiration date

****PRINT OUT THIS FORM AND FAX IT TO: (808) 734-1952

OR

MAIL TO: TRIBAL ARTIFACTS, INC.