PRINTABLE FAX ORDER FORM
PRODUCT SPECIFICATION
Choose Product:______________________________________________________
BILLING INFORMATION
Name: ______________________________________________________________
Company: ____________________________________________________ (optional)
Address: ____________________________________________________________
City: ________________________________________________________________
State/Providence: _____________________________________________________
Zip/Postal Code:_______________________________________________________
Country: _____________________________________________________________
Day Phone: ___________________________________________________________
Evening Phone: ________________________________________________________
Email: _______________________________________________________________
Fax: __________________________________________________________ (optional)
SHIPPING INFORMATION
Name: _______________________________________________________________
Company: ______________________________________________________(optional)
Address: _____________________________________________________________
City: _________________________________________________________________
State/Providence: ______________________________________________________
Zip / Postal Code: _______________________________________________________
Country: ______________________________________________________________
Fax it to 1-559-582-2011
