AntiStress
                             Fax Order Sheet
                          fax to: 281-481-0188
 
Name:  ______________________________________________________
 
Address:  ___________________________________________________
 
City:  ______________________  State: _______  Zip:  ____________
 
Country:  __________________________
 
Phone:  _________________________  Fax:  _____________________________
                                      
email:  _______________________________________
 
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 Product       Description          Price/Case      Quantity    Extended
                                                   Ordered      Total
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AntiStress    3 Gallon Case
Ready-to-Use  w/sprayer              $95.99        _______     ________

AntiStress    3 Gallon Case
Concentrate   12 Quarts/Case        $198.99        _______     ________
 
AntiStress    4 Gallon Case
Concentrate   4 Gallons/Case        $193.99        _______     ________
 
AntiStress    5 Gallon Case
Concentrate   Two 2 1/2 Gal. Jugs   $225.99        _______     ________
 

 
ShatterProof   3 Gallon Case
Ready-to-Use   w/sprayer             $95.99        _______     ________
 
ShatterProof  3 Gallon Case
Concentrate   12 Quarts/Case        $198.99        _______     ________
 
ShatterProof  4 Gallon Case
Concentrate   4 Gallons/Case        $193.99        _______     ________
 

 
AddLife       3 Gallon Case
Ready-to-Use  w/sprayer              $95.99        _______     ________

AddLife       3 Gallon Case
Concentrate   12 Quarts/Case        $198.99        _______     ________
 
AddLife       4 Gallon Case
Concentrate   4 Gallons/Case        $193.99        _______     ________
 
PepperGuard   All sizes             *POR            *POR        *POR
 
PepperGuard   All sizes             *POR            *POR        *POR
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Payment method:           |             Total                    ________
___ Check                 |
___ Money Order           |   Tax (Texas residents only, 8.25%)  ________
___ Credit Card           |
    ___ Visa/MasterCard   |         Shipping (call for costs)    ________
    ___ Discover/Novus    |
    ___ American Express  |         Grand total                  ________
 
                                  |Make Checks Payable to:
                                  |Domestic: Enviroshield Products Co.
                                  |Foreign:  Agricultural Mercantile, Corp.
                                
Card No. __________________________________  Expiration Date: ____________

                                     
Bank _____________________________

Signature:  __________________________________