Credit Card FAX Order
Please print all information clearly so we can process your order correctly and quickly.
Payments are in U.S. funds only. Fax the completed form to: 1-888-484-7373

1. Your name ______________________________________________________

and Email Address
(this enables us to locate your customer account and send email on your order's status)

2. Telephone Number: ___________________________________
(Only used if we need to contact you directly about the order.)

3. Billing Address


4. Shipping Address  U.S. Address ONLY!


(please specify apartments, suite numbers, etc.)

Product ID#
(See URL of Title)
Product Name & Description How Many Price
Total (Free Shipping USA Only!)

Thank you for your order! If you have questions, please contact us at Customer Service. We will send a confirmation email when your order is processed and shipped. Please allow 2-8 business days for U.S. orders. (Note: Please use different form for int'l orders).
Please FAX your credit card order to: 1-888-484-7373

Credit Card # ________________________________________ ( Visa / MC / Disc )
CSV Code: __________
(CSV is a 3 digit code on back of card for VISA/MC, none for Discover. We Don't accept AMEX.)

Exp Date: ______/___________ (MM/YYYY)

Name on Card: ___________________________________________