37 Prospect St. Amsterdam, NY 12010 Phone: 1-877-978-6898 Fax: 518-842-3455 FAX ORDER FORM Billing Information: Name:______________________________________________ Address:____________________________________________ ___________________________________________________ City:_______________________________________________ State:_____________________Zip Code:_________________ Phone Number: _____________________________________ Email:_____________________________________________ Fax: ______________________________________________ Shipping Information (if different from billing): Name:_______________________________________________ Address:_____________________________________________ ____________________________________________________ City:________________________________________________ State:_____________________Zip Code:__________________ Phone Number: ______________________________________ Email:______________________________________________ Fax: _______________________________________________ Sun Tzu Energy Drink (Case)   Price:$36.00 Quantity___________ Ext. Price_____________     Krank20 Caffeinated Water (Case)   Price:$24.00 Quantity___________ Ext. Price_____________     Subtotal__________________ NY State customers only: County___________________________Local Tax Rate_________________   Sales Tax__________________ Grand Total__________________ Please check one charity you would like to have 10% of your sale to go to: ___ National Multiple Sclerosis Society Card Holder's Name______________________________ Card Number:_______________________________________ Card Type: __________________________________ Expiration Date:____________________________________ Signature:___________________________________________________ (By signing above, I agree to have the amount listed above charged to my credit card) See www.fashionablebeverages.com for complete product descriptions and sales policies