Fax Order form
Fax number 607-936-8307
PRINT THIS ENTIRE PAGE, THEN FILL IN ALL THE INFORMATION , AND FAX IT TO US.
SELECT PRODUCTS
Dept. L
P. O. Box 667
Elmira, NY 14902
| Size | Quantity | Cost Ea. | Total |
| Small | $16.95 | ||
| Medium | $25.95 | ||
| Large | $34.95 | ||
| X-Large | $42.95 |
| Name: | ______________________________________ |
| Address: | ______________________________________ |
| City: | _______________State:____________Zip:__________ |
| Country: | ______________________________________ |
| Phone: | ________________________ |
| E-Mail: | ________________________ |
Credit Card Information:
Type:______________________
No._________________________
Exp. Date:__________________
All orders are shipped the same day we receive them.
All prices include postage inside continental United States.
All others add $9.00 US Shipping/Handling.