Golden City Professional Studies

                                  Fax Order Form
                                                     Fax to: 626-457-8852

Item #         Quantity#         Price $                                                                                              Shipping:

                                                                                                                                                           Regular Mail: $5.00                                                                                                                                                   
TP: _____ x ____  =  Price: $___________                                                                           Priority: $7.50  
                                                                                                                                                           Express: $25.00
TP: _____ x ____ =  Price: $___________               Shipping: $__________                 

TP: _____ x ____  =  Price: $___________              Total: $______________
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First Name ___________________________ M.I______ Last _______________________________

Address __________________________________________________________________________

City _________________________________ State ______ Zip ______________________________

Phone (_______)__________--___________ Fax (________)_____________--___________________

CC# ____________--_____________--_____________--_____________ EXP: _____/_____________

              SIGNATURE: ______________________________________________

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