Date: Thu, 18 Dec 1997 07:28:57 GMT Server: Apache/1.2.4 Last-Modified: Thu, 13 Nov 1997 07:12:57 GMT ETag: "4200f-2b7c-346aa879" Content-Length: 11132 Accept-Ranges: bytes Connection: close Content-Type: text/html Order Form for REALM Fragrances from EROX Corporation
Erox Corporation
4034 Clipper Court, Fremont CA 94538 ORDER FORM
For Fastest Ordering: Order Date: ______________
Call (888) 77 REALM or Fax (510) 226-6431

INSTRUCTIONS: Please print out this form (landscape suggested), and send it to the above address or FAX it to (510) 226-6431

REALM Women Collection
Number
of Units		 Item Size Price Extended
FREE SHIPPING AND
A BONUS GIFT IS YOURS
WHEN YOU ORDER
$50 OR MORE IN PRODUCTS

NEXT DAY, SECOND DAY,
HAWAII & ALASKA EXCLUDED
(Hawaii and Alaska see below)

______ Eau de Toilette 1.7oz 60.00 ____________
______ Eau de Toilette .15oz 20.00 ____________
______ Eau de Parfum 15ml 58.00 ____________
______ Moisturizing Body Lotion 6.8oz 35.00 ____________
______ Bath & Shower Gel 6.8oz 28.00 ____________
______ Perfumed Body Cream 6oz 55.00 ____________
______ Perfumed Body Talc 3oz 22.00 ____________
______ Roulette EDT .15oz 28.00 ____________
______ Refill for Roulette .15oz 17.00 ____________
______ Weekender Gift Set 36.00 ____________
______ Value Set 68.00 ____________
______ Parfum Set 45.00 ____________
______ On The Go Traveler Set 30.00 ____________
InnerREALM Collection for Women
Shipping & Handling
______ Eau de Toilette 2.49oz 65.00 ____________ Qty. Extended
______ Eau de Toilette 1.33oz 45.00 ____________
______ Moisturizing Body Lotion 6.8oz 35.00 ____________ First Item @ 6.95 ______ ____________
______ Bath & Shower Gel 6.8oz 28.00 ____________ Second Item @ 3.95 ______ ____________
______ Roulette EDT .15oz 28.00 ____________
______ Refill for Roulette .15oz 17.00 ____________ Next day $37.50 ______ ____________
Second Day $24.50 ______ ____________
Hawaii & Alaska, Add $20.00 ____________
REALM Men Collection
 SubTotal ____________
______ Eau de Cologne 1.7oz 60.00 ____________
______ Eau de Cologne .15oz 20.00 ____________ Shipping & Handling is taxable:
______ After Shave Balm 100ml 30.00 ____________ AZ 6.3%, CA 8.25%, FL 7.5%, MI 6%,
______ Bath & Shower Gel 6.8oz 28.00 ____________ NJ 6%, NY 8.25%, OH 6.5%, TN 8.25%,
______ Antiperspirant Deodorant 14.00 ____________ TX 8.25%, WA 7.0%
______ Weekender Set 36.00 ____________
______ Value Set 68.00 ____________ Tax ____________
______ On The Go Traveler Set 30.00 ____________ Total Order ____________

Billing & Shipping Information

    Credit card Number: ______________________________________   Expiration Date: ___________________   Type: _____________


    Name (on Credit Card): ___________________________________   Daytime Phone: ___________________________________________

                                                                 Ship To
    Name: ____________________________________________________   Name: ____________________________________________________


    Street: __________________________________________________   Street: __________________________________________________


    City/State/Zip: __________________________________________   City/State/Zip: __________________________________________

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