BILLING NAME AND ADDRESS:
| Name: |
| Address: |
| |
| |
| City: |
| State: |
Zip: |
| Daytime phone: |
| Fax number: |
| E-mail address: |
|
TO
ORDER:
Please print and fill out this form, then fax the order to:
FAX:1-928-768-5141
We will call you to confirm
your order total.
Monday through Friday,
9:00am - 5:30pm (Pacific Time)
Please Note:
If you do not want to Fax your credit card number, leave the credit card
number blank and be sure to include your phone number so we may call you between
the hours of 9:00am to 5:30pm PST to get the credit card number and confirm your
order. If you choose to leave the credit card number blank, you still need to
sign the form. |