Fax Order Form
914-767-0259

You can also use this form for mail orders . . . Mail your check or money order to:

IFB, International Food Brokers
19 Lily Pond Lane, Studio, Katonah, NY 10536, USA

Please make cheques payable to: IFB International Food Brokers
Print this form and fax it to us, or cut and paste it into your
word processor and fax-modem it to us at the above number.

Ship-to Name:         _________________________________________________

Shipping Address:     _________________________________________________

                      _________________________________________________

                      _________________________________________________

                      _________________________________________________

Credit Card Number:   _________  _________  _________  _________

Expiration Date:      ________________

Circle One:           VISA    EUROCARD/MASTERCARD   AMEX  DINER´S   JCB

Name on Card:         _________________________________________________

Phone Number:         _________________________________________________

E-Mail Address:       _________________________________________________

                                 # of pieces

------------------------------------------------------------------
The Product you'd like:   1-4          5+      Quantity  Amount
                          US$          US$
------------------------------------------------------------------
Imperial Torte large     93.00        83.00     ______   ______

Imperial Torte medium    83.00        73.00     ______   ______
  
Imperial Torte small     73.00        63.00     ______   ______


Total Order Amount:                      US$  ___________________

The above prices include all expenses and delivery charges for USA
and Canada only!

For Far East please add US$ 25.- for shipping



Date  __________________             Signature  ____________________