Fax Order Form

Fax Us Your Order! Please Print and Fax your order to: (661) 722-5669. If any faxing problems occur, please re-fax your order and mark your second fax as 'duplicate' or '2nd attempt'. Payment Form Check one: Visa __ MC __ AMEX __ Card# ________________________________________exp. ____ /____ CVV2# ________ Amount, US$ _______________ (Note - California Sales Tax will be added for CA Residents) Appropriate shipping and handling charges will be added to the total. Signature: _______________________________________________________________ Print Name & Date Signed: _________________________________________________ Item#(s) ________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Billing Name and Address on Card Name: __________________________________________________________________ Address: _________________________________________________________________ City: ____________________________________________ State: _____ Zip: ___________ Telephone: _____________________________ Fax: ______________________________ Email: __________________________________________________ Shipping Address (if different from above) Name: __________________________________________________________________ Address: _________________________________________________________________ City: ____________________________________________ State: _____ Zip: ___________