Invoice No: ___________

Invoice Date: ____________

“JAN ALI HATS”
2122 Massachusetts Avenue, N.W.
Suite 503
Washington, D.C.  20008
Phone:  (202) 223-2980
Cell:  (202) 316-6477
Fax:     (202) 331-4214

Bill To:                                                            Ship To:

___________________________________  __________________________________

___________________________________  __________________________________

___________________________________  __________________________________

___________________________________  __________________________________

Payment Due At Time of Order                                Shipping Method:  UPS Ground

Description of Item: ______________________________

Quantity _____________________________________________

Unit Price: ____________________________________________

Subtotal: ______________________________________________

Sales Tax (DC Customers - 5.75%) ________________________

Shipping via UPS _______________________________________

Total Invoice Amount ___________________________________

Payment Received: ______________________________________

Total Due: _____________________________________________

PLEASE NOTE:  NO EXCHANGE OR REFUND GIVEN ON PURCHASE

Customer Agrees to Permit Credit Card Transaction to be made by Jan Ali Hats on
___________ (Date) for the following Purchase:

Item Purchased: _________________________

Quantity of Items: _______________________

Unit Price: _________________

Sales Tax (DC Customers - 5.75%): __________

Shipping via UPS: _________________________

Total Credit Card Charge: ____________________

Name of Credit Card To Be Charged for Purchase: ____________________;

Credit Card No:___________________; Expiration Date: _________

I HAVE READ AND UNDERSTAND THE ABOVE TERMS:

Customer Signature: _____________________                   Date: _______________

(PLEASE FAX BACK TO JAN ALI HATS SHOWING SIGNATURE)

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