Name ____________________________________________     Date _______________

Address ________________________________________________________________

City   _____________________________ St _______________ Zip _______________

Phone   ___________________________ Fax _________________________

Email   ___________________________

Ship to (if different)

Address  _____________________________________________________________________________

City   ____________________________________ St __________________ Zip ____________________

Card Number ___________________________________     Exp date ___________

                                             Signature        ___________________________________

Check Enclosed ___

Print this page and either phone or fax the order to Arundo. Phone 503 647-0958 or Fax 503 647-5498