Sunset Survival & First Aid

Sunset Survival & First Aid :: ORDER BY FAX

ORDER BY FAX

TO ORDER BY FAX:

PLEASE PRINT OUT FORM, FILL OUT YOUR ORDER & FAX TO: 714-625-8582

(feel free to attach extra sheets if you need more space, or to add further order details)

or Call 714-369-8096 (866-637-3440 toll-free)

Sunset Survival & First Aid, 16835 Algonquin #142, Huntington Beach, CA 92649

Order Form

Name and Billing Info as it appears on your credit card bill (Visa/Mastercard debit cards also accepted)

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Name

_______________________________________ ___________________________ ______ _________

Address City State Zip

_______________________________________ ___________ __________________________

Credit Card Number Exp. Date CVV2 code (last 3 digits on back

Visa/MC, 4 digits front Amex)

_________________________ _____________ __________________________________________

Phone Number (required) Fax (optional) Email (optional)

Shipping Address if different from above: (If same, please check here ____)

Name: ________________________________________________________________________

_______________________________________ ____________________________ ____ _____________

Address City State Zip

SHIP Instructions:

Please circle one: GROUND 3-day 2-day OVERNIGHT

Coupon or Promo code (if applicable) _______________

Items ordered:

____________________ ________________________________________ _________ ________