Caviarteria                                 Ship To:                         
158 S. Beverly Dr.     29 East 60th St.      -------------------------------
Beverly Hills, Ca      New York, NY         |                               |
90212                  10022                |                               |
USA                    USA                  |                               |
                                            |                               |
1-800-287-9773         1-800-4-CAVIAR        -------------------------------
                                            Ship Via :
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| Page |       Item Description      |  Size  | Quant |  Price  |   Total   |
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                                               Total Merchandise|           |
                  ---------------                               |-----------|
Credit Card Type |               |                      Shipping|      $5.00|
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     Card Number |        :         :         :         |  Total|           |
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     Expiry Date |        /         |                   |
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       Signature |                                      |
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                 SOLD TO : (Statement Address only, see top 
                            of page for Shipping)
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