JFB Desktop Publishing

Lowelego Order Form

We do not trust the web with credit cards. There is always the possibility a talented hacker can compromise you.

Name:

Address:

Ship to Above Address

Ship to Below Address

Ship To:

Payment Options:	Mail with Cashier's Check
	Mail with Personal Check ( wait for check to clear)
	Pay by Credit Card

Card number : Expiration : Security code from back of card

Name on Credit Card:

Card Billing Address:

Home Phone with Area Code :

Day Phone with Area Code : Fax Number:

E-mail :

DESCRIPTION		PRICE	QTY	TOTAL
Lo wel Ego ( light)	E1-10	$125.00		$
Lowel Ego-sweep (Background)	E1-20	$30.00		$

		Sub Total	$
Ca Residents add sales tax		Sales Tax	$
U.S .Shipping Groundtrack ( $15.00) U.S .Shipping 3 day and Alaska and Hawaii ( $25.00) International $25.00 and up Depending on weight and destination			$
		TOTAL	$

We thank you for your support.

Signature:_______________________________