INTERNATIONAL FAX
To: GAKKEN CO., Ltd.
FAX:+81-3-3493-3338

Date:

I wish to order ______ copy (ies) of the "Ants of Japan",

Name:

(First)____________________________

(Surname)__________________________

Fax No. _________________________________

Signature ________________________________

<DELIVERY ADDRESS>

Name: _______________________________

Address: ____________________________________________

_____________________________________________

_____________________________________________

Country: ________________________

Phone: ___________________________

MESSAGE IF ANY:

N.B. Please write in BLOCK LETTERS