FAX ORDER FORM

TO JOIN OUR PRIVATE CLUB VIA FAX -Type in the information as needed in the spaces below. When you are done - hit PRINT on your computer and then just FAX the form to the number at the bottom of the page.
Your access code will be sent to you via e-mail withen 24 hours.
FAX LINES ARE OPEN 24 HOURS A DAY •• 7 DAYS PER WEEK
YOUR NAME
STREET ADDRESS
STREET ADDRESS continued
CITY
STATE
ZIP CODE
COUNTRY
YOUR E-MAIL ADDRESS REQUIRED
CREDIT CARD (choose one) M/C VISA DISCOVER AMEX
CREDIT CARD NUMBER
EXP DATE
TOTAL AMOUNT YOU OWE

$
ANY SPECIAL NOTES OR COMMENTS -TYPE HERE

READY TO ORDER?
Be sure all your information is included & correct
NOW hit "PRINT" on your browser - and then FAX this form to:

(203) 849-1594

You will be notified withen 48 hours of receipt -THANK YOU for your business!

Questions - Just ask us here

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