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714 S. Hill St., Suite 405, Los Angeles CA 90014 Tel. 213.817.5510 213.5.ETTIKA Fax. 888.809.8065 info@ettika.com www.ettika.com

Date ________________

pg. ____ / ____

BILL TO

SHIP TO

COMPANY

COMPANY

ADDRESS

ADDRESS

CITY

STATE

CITY

ZIP

PHONE/FAX

PHONE/FAX

BUYER’S NAME

SPECIAL INSTRUCTIONS

STATE

ZIP

EMAIL

REP

START SHIP

X FACTORY

TERMS

VISA

NET 30

WT

OTHER

CC COD

STYLE

QTY. SIZE

COLOR

AMEX

DISCOVER

NAME ON CARD

EXP. DATE

CARD NUMBER

DESRIPTION

Order is valid unless cancelled in writing by purchaser 5 days after order is placed. No Returns accepted without returnauthorization number. Any damages must be returned within 5 days of receipt of goods. All correspondence MUST be sent ONLY to the above address. By accepting this order you are personally guaranteeing its payment and agreeing to reimburse Ettika for all costs incurred in enforcing this contract, including actual attorney's fees.

SIGNATURE

MASTERCARD

UNIT PRICE

TOTAL

CCV#

AMOUNT

Ettika Purchase Order Form  

Ettika Purchase Order Form

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