714 S. Hill St., Suite 405, Los Angeles CA 90014 Tel. 213.817.5510 213.5.ETTIKA Fax. 888.809.8065 info@ettika.com www.ettika.com
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BILL TO
SHIP TO
COMPANY
COMPANY
ADDRESS
ADDRESS
CITY
STATE
CITY
ZIP
PHONE/FAX
PHONE/FAX
BUYER’S NAME
SPECIAL INSTRUCTIONS
STATE
ZIP
REP
START SHIP
X FACTORY
TERMS
VISA
NET 30
WT
OTHER
CC COD
STYLE
QTY. SIZE
COLOR
AMEX
DISCOVER
NAME ON CARD
EXP. DATE
CARD NUMBER
DESRIPTION
Order is valid unless cancelled in writing by purchaser 5 days after order is placed. No Returns accepted without returnauthorization number. Any damages must be returned within 5 days of receipt of goods. All correspondence MUST be sent ONLY to the above address. By accepting this order you are personally guaranteeing its payment and agreeing to reimburse Ettika for all costs incurred in enforcing this contract, including actual attorney's fees.
SIGNATURE
MASTERCARD
UNIT PRICE
TOTAL
CCV#
AMOUNT