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Modesty Magazine Subscription Savings Order Form

Name姓名:                                              
Company公司:                                         
Address地址:                                         
Postal Code郵政編碼:                                         
Telephone電話:                                         
Cheque支票:                                         
Signature簽名:                                         
Date日期:                                         

* GST excluded

Make the cheque payable to Modesty Group Inc.

Modesty Group Inc.
18 Crown Steel Drive, Unit 115
Markham, Ontario, L3R 9X8
Telephone: 905-513-1232
Fax: 905-513-0483

Email: ModestyGroup@Rogers.com