O R D E R F O R M

A Comprehensive Guide to Oriental and Specialty Rug Cleaningby Ellen Amirkhan and Aaron Groseclose

Name: ________________________________________________________________________

Shipping Address: _______________________________________________________________

City: __________________________________ State:__________Postal Code: _____________

Telephone:______________________________Email: _________________________________

PAYMENT BY CREDIT CARD

MasterCard Visa AMEXExpiration Date: _________________________

Card Number:_______________________________________Security code: _______________

Name on Card: _________________________________________________________________

Billing Address (if different from shipping address):

_____________________________________________________________________________

_____________________________________________________________________________

Number of Books: _________ @US $495.00 = $___________

Shipping & Handling: $15/book with the U.S. $___________

(8.25% sales tax Texas) $___________

Total Amount Due: $ __________

MASTER RUG CLEANER PROGRAM

Phone: (214) 821-9135 Fax: (214) 821-9136 www.masterrugcleaner.com