Order Form

	African Northwest, Inc.

Please provide the following contact information:

Store Name

Ordered By

Phone #

FAX

E-mail

Please provide the following ordering information:

QTY	CODE	DESCRIPTION

	BILLING
Purchase Order #
Account Name

	SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Enter the date of ... :
-- mm/dd/yy
Enter the time of ... :
-- hh:mm:ss am/pm

African Northwest, Inc. / 470 South Kenyon Street / Seattle, WA. 98108
(206) 267-4434 / (800) 758-7674 / Fax: (206) 267-4457 / Toll free fax (888) 279-3318