Mail or Fax in your order Print out the following order form and either: Fax it to (877) ENTHEMS Snail mail it to: The eNthem Company 1440 Naugatuck Avenue Milford, Connecticut 06461

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Name: _________________________

Email: _________________________

Company: _________________________

Address: _________________________

_____________________________

City: ____________________________

State: _________

Country: _________________________

Zip: _________

Phone: (___) ____ - ______

(  ) I am enclosing a check or money order for $699 USD. Please note that we do not accept checks by fax, so if you are paying by check you must mail it in.


(  ) I want to charge $699 USD to my Credit Card Note:

Credit Card (circle one):
VISA
MasterCard
American Express
Discover

Card Number: _________________________

Expiry Date: _________

Signature: _________________________

I authorize The eNthem Company to charge $699 USD to my credit card for the purchase (and shipment) of the eNthem.