AmEn Selah Ltd

All Business Is Done At Your Convenience This is an explanation of the purpose of the form

Please provide the following contact information:

First name

Last name

Title

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

FAX

E-mail

URL

Please Enter The Names or Numbers and Quantities of the Products In the Square Box Provided Below:

(May we suggest the 'cut', 'copy' and 'paste' system provided in the edit part of your browser)

(ex : Map , M1 , 5)

Please provide the following ordering information so we may process your order successfully Allow Two To Three Weeks To Process Your Order

If you wish you may print out this order form and fax it to this number: 1-972-(0)-4-8218211

All products are shipped within two to three weeks after receipt of your order.

All payments are done by either certified cheque or money order

Prices do not include shipping or handling

BILLING

Contact Person

Company name

Method of Payment : Certified Cheque or Money Order

SHIPPING

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Should you choose to not process your order by email, we can be reached by regular post at

AmEn Selah Ltd

P.O. Box 2201, Tiberias, Israel. 14100

Or by the following phone numbers here in the Holyland

Regular : 972-(0)-4-8218211/972-(0)-50-5513449 / 972-(0)-52-2692297 Fax: 972-(0)-4-8218211