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kangaUSA Fax & Mail Order Form

Please print this form and complete. Please print clearly. Thanks!

Kanga Style Quantity    Price

.

 Total
Style 1 .  x   $20.00  =             .00
Style 2 .  x   $20.00   =              .00
Style 3 .  x   $20.00   =              .00
Style 4 .  x   $20.00   =              .00
Style 5 .  x   $20.00   =              .00
Style 6 .  x   $20.00   =              .00
Blue Obama Kanga .  x   $18.00   =              .00
Clkcoo .  x   $16.00  =             .00
White Obama Kanga .  x   $18.00  =             .00
Style _______ .  x   $16.00  =             .00
Style _______ .  x   $  =             .00

Subtotal 

            .00

     Enter Shipping Charges  

        .

Total 

         .

Payment Method (please circle one).

Visa    MasterCard   PayPal    Check/Money Order (Made payable to "Aina Moja")

SHIPPING INFORMATION

BILLING INFORMATION
(Only complete if paying with a credit card.)
Ship to Name:

.

 Cardholder's Name:

.
Address: .

.

 Billing Address: .
City: . City: .
State: . State: .
Zip/Postal Code: . Zip/Postal Code: .
Country: . Country: .
E-mail Address: .  Best Phone Contact: .
 Daytime Telephone: .  Credit Card Number: .
Evening Telephone: .  Expiration Date: .


Fax To:
207-722-3809

Mail To:
kangaUSA
Aina Moja Shop
The Working Art Gallery
65 Main Street
Belfast, ME 04915 USA
KangaUSA.com is a project of Expanding Opportunities, a 501(c)3 organization.
For additional Kanga selections and other African items; visit our other African Stores at: AinaMoja.com and 1st AfricanClothing.com.


Copyright © 2008 All Rights Reserved