Please PRINT this form on your printer,

Then

Fill the form out and fax it to Figure 8 at  (613) 736-7747

Date: _____________________________

I, ________________________________, authorize Figure 8 Boutique Ltd.

to bill my (circle one) VISA , MASTERCARD or American Express credit card

q for the amount of $ __________________

q for the merchandise purchased via Figure 8 website order conf. #_____________

q the following items plus shipping

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Card Number: __________________________________________________________

Expiry Date: ___________________________  ( month / year )

Name as it appears on the card: ___________________________________(please print)



Signature: ______________________________________

I agree to pay the above total amount according to the card issuer's
agreement.

Please fax back total amount charged on my card to the following fax number

My fax fax number is: __________________________________