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Fax/Mail Urgent: A.C.E.S., INC. ORDER FORM      Date:_____________

To: A.C.E.S., Inc.*3700 NW 124th Avenue*Suite 132*Coral Springs, FL 33065*USA
Fax: 954-346-8000 Phone: 954-755-9550 Mobile: 954-383-5124

Name:                                                                     Phone Number:
_______________________________________________________________
Address:
_______________________________________________________________
City, State, Zip, Country
_______________________________________________________________
Your E-Mail address:(You must provide this to receive your confirmation)

_______________________________________________________________
PRODUCTS:(all prices listed in US Funds) - Please circle product or bundle.

Shipping Type:(Circle One) -- International customers are responsible for any custom/duty charges.

UPS Ground within USA $      US Post Office Priority Mail: $ (in US)    

International Shipping: $      International UPS: $

Payment Type:(Circle)

VISA     Master Card       Discover       American Express

Name (Exactly as it appears on the Card):
_______________________________________________________________

Card Number:    __________________________________________________

Card Expiration Date:  ______________________________________________

Authorized Signature: ______________________________________________

Thank you for your Order!