
| If you prefer, you can place your order by mail or fax. Print this page and use the form below. Fill out all sections. Mail your completed Order Form along with your check or money order to address below. Or you can FAX your order to: 805.226.8657 All info is kept private (See our Privacy Policy) |
| Order Form |
| Mail or FAX to: 805.226.8657 |
| BILL TO: Name: ________________________________________ Address: ______________________________________ City, State, Zip _________________________________ Phone: _______________________________________ Email address:_________________________________ |
| SHIP TO: Name: ________________________________________ Address: ______________________________________ City, State, Zip _________________________________ Phone: _______________________________________ Email address:_________________________________ |
| Credit Card orders please circle one: |
| Visa MasterCard American Express Discover |
| Account Name: ___________________________________ Expiration Date: Month ___________ Year ________ Account Number:_____________________________________________ CVV: ___________ (3 digit # on back or 4 digit # on front) Must provide phone# and email address to process order. |
| THANK YOU FOR YOUR ORDER! We look forward to you shopping with us again real soon. |
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| Wholesale Orders - Please complete the following: Name of Owner: _______________________________________________________ ReSale #: __________________________ Company Name: _______________________________________________________ First Order: Yes ____ No ____ $200.00 Minimum Order / Call or Email for Wholesale Pricing |