ALL VETERINARY SUPPLY INC.

                                                                                FAX ORDER FORM

                      Name: ________________________________________________

                      Email Address:_____________________Ph.#_________________

                      Shipping Address:_______________________________________

                              _____________________________________________________________________

                       Credit Card Type(Circle One)Amex, Visa, Discover, Mastercard

                       Credit Card #: __________________________________________

                       Expiration Date:________________________________________

                       3 Digit Vcode: __________________________________________

                        Credit Card Billing Address:________________________________

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                                                                Products Wanted:

                                ________________________________________________ Quantity______________

                                ________________________________________________ Quantity______________

                                ________________________________________________ Quantity______________

                                ________________________________________________ Quantity______________

                                 ________________________________________________ Quantity______________

                                 ________________________________________________ Quantity______________

                             Please Print this form, fill it out and fax back to 305-599-6148.