ETX ORDER FORM

To mail or fax your order, print this form and follow directions below. To place your order by phone,

call toll-free (877) STAR-ETX (877-782-7389). To order online, go to the secured Shopping Cart.

Name: _________________________________________________________________

Address: _______________________________________________________________

City: _______________________________ State: ________ ZIP: _________________

Country: _______________________________________________________________

Telephone: ( ) ________________ Email: ________________________________

If paying by Visa or MasterCard, please enter: Expiration Date: _______/_________

Card Number: ___________________________________________________________

Signature: ______________________________________________________________

. Send PayPal payments to "ETX @ comcast.net" and email a copy of your order.

Item# / Description	Quantity	Price Each	Item Total







SUBTOTAL
California residents add Sales Tax. (Multiply SUBTOTAL by .0775) CA TAX
SHIPPING: $1- $49 = $5.00 \| $50 - $99 = $8.50 \| Over $100.00 = $10.50. Foreign Surcharge (Airmail service to countries outside U.S.): Add $10.00. SHIPPING
Universal Currency Converter TOTAL

Fax this completed order form to (916) 760-0823 or mail with your payment to:

ETX, Box 22201, Sacramento, CA 95822-0201 USA

Satisfaction Guaranteed! Customer Service