        
        
                    Carmen Electra  screen saver order form
                    
                    
                    Name            :__________________
                    
                    e-mail           :__________________
                    
                    Date             :___/_____/2002
                    
                    Please send a cheque/money order
                    amount of $10.00 in US or CND. Fund
                    payable to :
                    
                                         Mansel Ozanalp
                                         
                                         374 Winchester st.
                                         Winnipeg Manitoba
                                         Canada  R3J2E6
                                         
                    Your registration Code will be in your
                    e-mail.   Thank you.
                    
                                       