Fax in your order Print out the following order form and either: Fax to our US Fax number  011-39-212-918-9012 (fax) *Note shipping more items will proportionally decrease shipping costs since all items are shipped from italy Qty. Description Price Extended Shipping ( 0 kg) $0.00 Sub Total: $0.00 Total: $0.00

Name: ________________________________ Email: _______________________________ Company (for B2B): ___________________ Address: _____________________________ City: __________________________ State: __________ Country: ____________   Zip: _________ Phone: (___) ____- ______   (  ) I am sending a  check or money order to  LifeInItaly c/o Paolo Nascimbeni 5909 Bethlehem ct Rockville, MD 20855 USA (  ) I want to charge this purchase to my Credit Card Credit Card (check one): ___ VISA ___ MasterCard ___ American Express ___ Discover Card Number: ___________________________    Expiry Date: _______   Signature: _____________________________ (  ) I authorize MOD (Maioliche Originali Deruta) c/o LifeinItaly to charge my credit card for the purchase below  or (  )  I am only requestiong a shipping time estimate - Do not charge my credit card at this time ITEM ID  CODE    DECORO    DESCRIPTION      QUANTITY      COST   ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________