Fax/Mail Order Form

Print out and then either...

Fax +49-6135-950617
or mail to address below.

Aladin's Egyptian Art Shop Order Form

Ordered From:

Ship To (if different):

Name: ______________________

Address: ____________________

City: ________________________

State: ______________________

Zip: _______________

e-mail: _____________________

Name: ______________________

Address: ____________________

City: _______________________

State: ______________________

Zip: ____________

e-mail: _____________________

[ ] MasterCard [ ] Visa [ ] Diners

Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Card Expiration: __________
Cardholder's name: _______________________________

Signature: _________________________________________________

	Fax:	Mail:
	+49-6135-950617 Tel: +49-6135-950616	Aladin's Egyptian Art Shop Claudia Weyl Walterpfad 6 55294 Bodenheim Germany