Fax Order Form
If you're going to order by
Fax, print this form, fill out the form completely then fax the form to us at 1-
727- 712- 2346. Or you can mail it to us at, Rip n Roll - P.O. Box
14301 - Clearwater, Fl 33766
Name: _____________________________________________
Street: _____________________________________________
City: __________________ State : _______________________
Zip: _______________ Country: _________________________
Telephone # __________________E-Mail __________________
Method of Payment (check one)
| ____ Visa | ____ Mastercard | ____ American Express |
Card Number: ________________________________________
Expiration Date (month/year) : ____________________________
Name on the card: _____________________________________
Signature: ___________________________________________
Stuff you're buying Today
Item Number: _____________ Qty: ____ Description: ____________________ Price $ ________
Item Number: _____________ Qty: ____ Description: ____________________ Price $ ________
Item Number: _____________ Qty: ____ Description: ____________________ Price $ ________
Item Number: _____________ Qty: ____ Description: ____________________ Price $ ________
Item Number: _____________ Qty: ____ Description: ____________________ Price $ ________
Florida Residents only, add your county sales tax (check one)
| ___ 6 % | ___ 6.5 % | ___ 7 % | ___ 7.5 % |
Shipping Method (check one)
| ___ First Class $0.00 | ___ Priority $5.75 | ___Canada $5.75 | ___ Next Day Air $18.50 | ___ International $15.00 |
Total: _____________________
Thank you for your order. Home ©1997-2008 (www.RipnRoll.com) Rip n Roll Inc.