TAGSHIELD

Fax Order Form For Credit Card or Check

Item # 1 __________________________________________price ____________

Item # 2 __________________________________________price_____________

Item # 3 __________________________________________price_____________

                        (Attach a sheet for additional items)

..........................................................................SUB-TOTAL _____________

............................................................................SHIPPING _____________

..................................................................................TOTAL ____________

If sending check simply tape top edge of filled out check along this line of text

Make check payable to: Ankh Het Auset

or

Credit Card type: circle one......Visa..........MC...........Amex.............Discover

Credit Card # ____________________________________ Expires_____________

Name On Card ___________________________________

Telephone#_______________

Shipping Address___________________________________________________________

City__________________State___________________Zip_____________________

I authorize this transaction (signature)________________________________________

Email address _____________________________________________________

After you print this form out fill in appropriate information and Fax to: (Toll Free) 877-287-6156

or

Mail to: Ankh Het Auset---TAGSHIELD---P. O. Box 60357---Washington, DC 20039

You may also call us at (Toll Free) 877-287-6156