Printable Order Form for Mail Order
(Go to "File" and "Print")
or Order Online
Please print clearly. Fields marked with an asterisk (*) are required
to process this order.
Use the BACK button on your browser to return to the previous
page.
| Customer
Name: |
| Address: |
| |
| Day
Phone: |
Eve.
Phone:
|
Fax: |
E-mail: |
|
| Qty |
Item |
Description |
Price |
Total |
| |
|
Nanogen Fibers - Color(s): |
|
|
| |
|
|
|
|
| |
|
Nanogen Fiber
+ Locking Mist Kit |
|
|
| |
|
Color(s): |
|
|
| |
|
|
|
|
| |
|
Nanogen
Locking Mist |
$8.99 |
|
| SUBTOTAL: |
|
SALES
TAX:
(9.25%
in TN) |
|
| SHIPPING
(USA ONLY): |
$6.99 |
| TOTAL
AMOUNT: |
$ |
| PAYMENT
INFORMATION |
| PAYMENT
TYPE:* (Please select one.) No Cash or C.O.D. accepted.
Check/money order payments accepted with postal mail orders
ONLY. |
| |
| **
Make checks payable to: Sunset Marketing (checks must
be in US dollars ONLY) CREDIT
CARD PAYMENT INFORMATION: |
| TYPE
OF CARD:* |
| |
| CARD
NUMBER:* (Must be 16 digits) |
EXP.
DATE* |
|
| |
| | |
| | |
| | |
| | |
| | | |
| CARDHOLDER'S
NAME AS IT APPEARS ON THE CARD:* |
| |
| CARDHOLDER'S
SIGNATURE:* (Orders can not be processed without signature) |
| |
Mail your order /
check payable to:
Sunset
Marketing
554 Green Tree Cv
Suite 201
Collierville, TN 38017
888-849-8686
(toll free ordering ~ 9-5 Central Time ~ Mon.-Fri.)
|
