Authentic Africa Fax Order Form

To order by
Fax or Phone Dial:

1-888-340-9286

Mail to:
Authentic Africa
13 South 51st Street
Philadelphia, PA 19139

http://www.authenticafrica.com/

Customer Service: 1-888-340-9286

Bill To:		Ship to (if different from Billing):
Name		Name
Address		Address
City, State, Zip		City, State, Zip
Telephone with Area Code		Telephone with Area Code
Email address		Email address

Quantity	Item Number	Description/Options	Price	Weight	Total





Subtotal
NY residents add 8 ¼% tax
Shipping cost (as sent via E-mail)
Total Including Shipping and applicable tax

SHIPPING INSTRUCTIONS:

Please print this entire page with complete information and send to us. We will then E-mail you the total with shipping. Upon confirmation of the charges, we will ship the order to you.

TO DETERMINE SHIPPING COST, PLEASE LET US KNOW YOUR PREFERRED METHOD OF SHIPPING (2 DAY PRIORITY, UPS, USPS STANDARD)

For International rates, please contact us.

Please Indicate Method of Payment:

Check Enclosed* ___ Money Order Enclosed*___

Master Card ___ Visa ___ American Express ___

Account Number __________________________________

Expiration Date _________

Name as it appears on your card ____________________________

Signature ___________________________________

*Check(s)/Money Order(s) must be received within 7 days of Fax.