SOVRANA TRADING CORPORATION                    TOLL-FREE PHONE: (866)  SOVRANA
14928 SOUTH FIGUEROA STREET                                FAX: (310) 217-1832
GARDENA, CA  90248                         CORPORATE WEB SITE: www.sovrana.com
(310) 323-3357                             ONLINE STORE:  www.sovranastore.com  
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                             FAX ORDER FORM (PRINT)


BILL TO:        ___________________________________ --> IMPORTANT: SAME AS IT 
                ___________________________________     APPEARS ON YOUR CREDIT
                ___________________________________     CARD STATEMENT.
                ___________________________________

TELEPHONE (DAY) (_____)____________________________ --> REQUIRED!
TELEPHONE (EVE) (_____)____________________________ --> OPTIONAL
E-MAIL ADDRESS  ___________________________________ --> OPTIONAL

SHIP TO:        ___________________________________ --> CHECK HERE IF SHIPPING
                ___________________________________     ADDRESS IS THE SAME AS
                ___________________________________     BILLING ADDRESS: ( )
                ___________________________________


PAYMENT         C/C NUMBER (Visa, MasterCard, AmEx, Discover cards accepted):
METHOD:
                #_______________________________________  EXPIRES ON: ____/____


Please obtain desired Item ID# and product description by browsing our Online 
Store and write them in the spaces provided below (one item per line), with 
number of units ordered, unit cost and extended price. We will contact you at 
the phone number or email address provided above to confirm total price of your 
order, inclusive of shipping charges and sales taxes, if applicable.


ITEM ID#  UNITS  DESCRIPTION                               UNIT $     EXTEND. $
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________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________
________  _____  ________________________________________  _________  _________

TOTALS:   _____                                                       _________


SHIPPING METHOD (check one):  ( ) GROUND    ( ) 3-DAY SELECT   ( ) NEXT-DAY AIR

Note: For your convenience, our shipping charges are listed on our Online Store 
at the bottom of our "Shopping F.A.Q." (click on this link from our Home Page).

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  FILL OUT AND FAX THIS PAGE TO 310-217-1832. WE WILL CONTACT YOU SHORTLY WITH
  ORDER CONFIRMATION, TOTAL INCLUSIVE OF SHIPPING AND TAXES, AND SHIPPING DATE.
                                   THANK YOU.