Fantazia Concepts P.O. Box 5142 Willowick, OH 44095 216-951-5666 Voice E-Mail Address: FantaziaC@AOL.COM 216-951-9241 Fax 800-951-0877 Toll Free Order Line Name_________________________________________________ Company______________________________________________ Address______________________________________________ ______________________________________________ City_________________________________________________ State_________________ Zip_________________________ Providence:_________________ Country:________________ Phone_________________ Fax___________________________ E-Mail Address:______________________________________ Qty.___ Item_____________________________ Price______ Qty.___ Item_____________________________ Price______ Please add $5.00 for shipping. ($9.00 Oversees) Additional charges: $5.00 for next day, $5.00 for C.O.D All orders shipped Fed. Ex. 2 day. Please no P.O. Boxes for orders. Payment method Cash, Check, Money Order, Visa, Mastercard or Discover Card #_____________________________Exp. Date_________ Name on Card_________________________________________ Signature____________________________________________ Would you like to be on our mailing list_____________ Do you know anyone who would like to be on our mailing list? Y/N Name_________________________________________________ Company______________________________________________ Address______________________________________________ ______________________________________________ City_________________________________________________ State_________________ Zip_________________________ Providence:_________________ Country:________________ Phone_________________ Fax___________________________ E-Mail Address:______________________________________ Name_________________________________________________ Company______________________________________________ Address______________________________________________ ______________________________________________ City_________________________________________________ State_________________ Zip_________________________ Providence:_________________ Country:________________ Phone_________________ Fax___________________________ E-Mail Address:______________________________________