DawnCopy Pick Up Date __________ Return By_____________  Marie Copy Pick Up Date Return By_____________  Pazzo Copy Ship by________________

Piccolo Pazzo

Page 22

Consumer Data Order Form

Customer Name______________________________________________________Date_______________ Pro Shop____________________________________________Buyer______________________________ Street Address______________________________________________Apt. #________Ste.#__________ City_______________________________State/Country____________________Zip_________________ Telephone No______________________________Telephone No_________________________________ Fax No.________________________________E-mail___________________________________________ Payment Method: Cash / Check______Visa______Master Card______Discover______Amex______ Name on Card__________________________________________________________________________ Card No._________________________________________________Exp___________________________

Total Amount of Order US$:_______________________________ Shipping Cost:                       ______________________________ Total Amount of Order US$:_______________________________

Shipping Address if different from above address.

Name of Addressee______________________________________________________________________ Shipping Address________________________________________________________________________ City____________________________________________________State___________Zip_____________ Telephone No.________________________________________________________________________

Shipping Charges

International: Request Quote

Minimum  $35.00:       $5.50 $36.00    to $50.00:      $6.50 $51.00    to $80.00:      $9.50 $81.00    to $110.00:   $12.50 $111.00  to $149.00:   $14.50 $150.00  to $199.99    $18.50

$200.00  to $299.00:       $22.50 $300.00  to $399.00:       $24.50 $400.00  to $499.00:       $28.50 $500.00  to $599.00:       $32.50 $600.00  to $699.00:       $35.50 $700 plus depends on weight.

Place Order by:  Toll Free Hot Line 1-888-636-3102 Ask for Nick Facsimile: (360) 263-5552            E-mail: sales@pazzogolf.com

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(Material Series)

(Price List)

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