FAX ORDER FORM - 1-866-385-4930 (Please Print this Page)
Name _________________________________________
Tel (H) ________________
Address ________________________________________
Tel (W)________________
City ______________________________ State ______ Zip/Postal
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E-Mail __________________________________________
Pool ____
Spa ____ Chemicals
_____ Backyard ____
Qty Description
Unit Price Total
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Sales Tax (CT) __________
Shipping
__________
Total
__________
Method of Payment:
Sending Check ____* Call me for my Credit Card ___
Here's my Credit Card information:
Card #________________________________ Exp ________
Signature__________________________________
Thank you for your order! We will telephone you to
confirm this order and/or to
take your credit card information.
*We will process your order after we have received your check and it has cleared.