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INSTRUCTIONS:  Please print this page and fax it to (321) 777-9058
or call us at (321) 777-5936 with your order.

Ordered By:  (Please print CLEARLY!)

Name:  

_________________________________________________

Address:  

______________________________________________________________

City:  

________________________

State:  

________________________

ZIP:

__________________

Country:  

________________________

Telephone:  

_________________________________________________

Ship To:  (If different then above)

Name:  

__________________________________________________

Address:  

______________________________________________________________

City:  

________________________

State:  

________________________

ZIP:

___________________

Country:  

________________________

Telephone:  

__________________________________________________

 


Payment Options:  (Select One)

Money Order (Amount):

VISA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date: (MM/YY) Security Code: _______(on signature Strip)

MasterCard:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date: (MM/YY) Security Code: _______(on signature Strip)

Discover:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date: (MM/YY) Security Code: _______(on signature Strip)

If paying by credit card, please sign below:

Signature:_______________________________________

Date:______________

Item #

Description

Color

Size

Qty.

Unit Price

Total Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Shipping is based on order size and shipping method (Ground or Air)

You will be notified of the shipping charge before your order

is processed.

Boards require special rates, please call for details.

Shipping & Handling*

 

Sales Tax (Florida residents only)

 

 Grand Total

 

Contact Information:

Telephone: (321) 777-5936          Fax: (321) 777-9058
Address: 131 Tomahawk Drive, Unit #25, Indian Harbour Beach, Florida, USA   32937
e-mail: Rain@RDistributing.com