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WE TAKE CREDIT CARDS BY PHONE, FAX, MAIL AND EMAIL
Please print out this form, then complete and FAX to
877-933-7111 Toll Free Name: ______________________________________________________________________________ Shipping Address: _____________________________________________________________________ City: ________________________________________ State: ___________ Zip: ___________________ Daytime Phone: _______________________________ Evening Phone: __________________________ IF PAYING BY CREDIT CARD: (MasterCard, Visa, and Discover Only):
Cardholders Name: ____________________________________________________________________________ Credit Card Number: ________________________________________ CVV: __________3 or 4 digit no. on back of card Expiration Date: __________________ Signature: ___________________________________________________ Address where monthly billing is sent (if different from above): Billing Address: ________________________________________________________________________________ City: __________________________________________ State: _____________ Zip: _________________________
IF PAYING BY CHECK, please allow 3 weeks for delivery.
NOTE: ALL RETURNS MUST BE AUTHORIZED AND ARE SUBJECT TO A
15% RESTOCKING FEE. FREIGHT CALCULATOR:
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Last modified: 06/16/2008 |
