Fax OrderForm
  • Fill out and Fax or Call 1-888-276-1727
  • U.S. Fax (619) 276-6609
CREDIT CARD BILLING ADDRESS
E-Mail:
First Name:
Last Name:
Business Name:
Street Address:
Address Line 2:
City:
State/Province:
Postal Code/Zip:
Work Phone:  (             )            -
Home Phone: (           )         -
SHIPPING ADDRESS (only fill out if different)
First Name:
Last Name:
Business Name:
Street Address:
Address Line 2:
City:
State/Province:
Postal Code/Zip:

 

PRODUCT TO ORDER        

Description  

 Color Size Qty Price
1)        
2)        
3)        
4)        
5)        
6)        
7)        
8)        
9)        
         
   

Subtotal

  

California Sales Tax ( only if you live in California) 7.75%:

  
Shipping Cost (located Below):  
Total:  
SHIPPING INFORMATION (Check one of the boxes)

 

BILLING INFORMATION
Credit card:
Cardholder name:
Bank Name:
Card number:
Expiration date:
Toll free CC Number: 1-800-

Please enter the "800" Customer Service Number on the
back of your credit card.  Needed for verification purposes.
Credit Card Companies allow retailers to verify billing addresses.
This is for protection of the card holder and the retailer.
Internet Credit Card Fraud is a serious matter.

International Customers:  For Verification, please fax a copy of your
credit card and Drivers Licensee
Copyright information goes here.
Last revised: January 28, 2008