Pentagram

ORDER FORM FOR DARBUKA / KAV HATEFER CD / BOOK

ITEM NAME PRICE PER UNIT NUMBER OF ORDERS AMOUNT DUE

Darbuka 195.00 $------------------------- --------------------------------- $

Shipping for darbuka 43.00 $------------------------- --------------------------------- $

Extra head 12.00 $------------------------- --------------------------------- $

Kav Hatefer CD + shipping 15.00 $------------------------- --------------------------------- $

“Art of Middle Eastern Rythms” Book +6 CD's          72.00 $------------------------- --------------------------------- $

Total $

1. Items will remain in “Pentagram’s” ownership until payment is settled.

2. This order will remain valid for 30 days from when it is received.

3. All items will be shipped by EMS airmail.

4. Please allow 3 weeks for delivery.

Please fill out this next information (in print) :

First and Last Name + Middle Initial __________________________________________________

Company Name Contact Representative_________________________

Billing Address____________________________________________________________________

Phone #____ Fax # ____________________

Email:______________________________

Mailing Address ( if different than above)_______________________________________________

Type of Credit Card_________________Credit Card #________________________________

Valid Until__________

Your Signature________________________________

Other Comments or Requests_________________________________________________________________________

Fax this form to: 972 3 9032938

or mail to: Y.A. Ametis

5 Yekutiel Adam St.

Kfar Saba, Israel.

(tel) 972 3 9032911