Name:___________________________
Address:__________________________
City:________________State_______Zip______
Phone:(____)____-_____Ext____
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Bill To:
Item#
Description
Qty
Unit Price
Total
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_______________________
Item Total
California Residents Please Add 8.0%
Packing & Shipping Fee
Grand Total
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*You will receive a
   free mystery gift
         with your
         Fax order.
                                     Fax Order Form
                              Cynthia's Amazing Products
                           1126 N. Mountain Avenue #1015
                                      Ontario, CA 91762
                                   FAX  1(888) 313-5796
(Once you hear the main greeting, Press ''Send'' on your fax machine.)
               Email: support@cynthiasamazingproducts.com
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Order Date: _____/_____/_____
Charge To:
(as printed on card)
Print Order Form, Fill In, Then FAX ...
Signature__________________________
Ship To:
Name:___________________________
Address:__________________________
City:________________State_______Zip______
Name:___________________________
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Card # _____-_____-_____-_____

Exp. Date ____/____ Zip Code______

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(Last 3 digits on back of card, 4-digit on front for AMEX)