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Text File  |  1994-07-19  |  3KB  |  56 lines
  1.         Fantazia Concepts
  2.         35143 Vine Street
  3.         Eastlake, OH  44095
  4.         216-951-5666  Voice       E-Mail Address: FantaziaC@AOL.COM
  5.         216-951-9241  Fax
  6.         800-951-0877  Toll Free Order Line
  7.  
  8.         Name_________________________________________________
  9.         Company______________________________________________
  10.         Address______________________________________________
  11.                ______________________________________________
  12.         City_________________________________________________
  13.         State_________________   Zip_________________________
  14.         Providence:_________________ Country:________________
  15.         Phone_________________ Fax___________________________
  16.         E-Mail Address:______________________________________
  17.  
  18.         Qty.___ Item_____________________________ Price______
  19.         Qty.___ Item_____________________________ Price______
  20.  
  21.         Please add $5.00 for shipping.
  22.         Additional charges: $5.00 for next day, $5.00 for C.O.D
  23.         All orders shipped Fed. Ex. 2 day.
  24.         Please no P.O. Boxes for orders.
  25.  
  26.         Payment method
  27.         Cash, Check, Money Order, Visa, Mastercard or Discover
  28.  
  29.         Card #_____________________________Exp. Date_________
  30.         Name on Card_________________________________________
  31.  
  32.         Signature____________________________________________
  33.  
  34.         Would you like to be on our mailing list_____________
  35.         Do you know anyone who would like to be on our mailing list? Y/N
  36.  
  37.         Name_________________________________________________
  38.         Company______________________________________________
  39.         Address______________________________________________
  40.                ______________________________________________
  41.         City_________________________________________________
  42.         State_________________   Zip_________________________
  43.         Providence:_________________ Country:________________
  44.         Phone_________________ Fax___________________________
  45.         E-Mail Address:______________________________________
  46.  
  47.         Name_________________________________________________
  48.         Company______________________________________________
  49.         Address______________________________________________
  50.                ______________________________________________
  51.         City_________________________________________________
  52.         State_________________   Zip_________________________
  53.         Providence:_________________ Country:________________
  54.         Phone_________________ Fax___________________________
  55.         E-Mail Address:______________________________________
  56.