Fischer Pharmaceuticals Inc.

Order Form
Due to security of transmitting credit card details, we would recommend
to fill out the required details on a printed page of this order form
and send it to the following fax number:

Personal Details

First Name: ________________ Middle Initial: ___________ Last Name:__________________

Mailing Address: _____________________________________

City: _______________ State: _______ Zip Code: _________

Country: ____________

E-Mail: ______________________ Tel: ____________________ Fax: ___________________

Price: $69 (USD) per book

The price includes:
* V.A.T
* Shipping & handling (by Air Mail for international orders)

Credit Card Details

Type of Credit Card: _________________________ (Visa/American Express/MasterCard/Diners)

Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Expiry Date: |__|__|-|__|__|-|__|__|

Card Holder's Full Name:______________________

Your Order

I would like to order ____ copy/copies of "Artists Messengers of Peace",

I would like you to confirm my order via: __e-mail; __fax; __phone.

_______________                   _____________
Signature                         Date

Thank you for your order.
Please allow 14-21 days for delivary.

The Collection is by the Courtesy of Fischer Pharmaceuticals Ltd.

Designed and supported by NETMOR LTD.