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Order Form for Faxing or
Mailing |
To place an order using your credit card by Voice Call: 1(800)577-7646 or PRINT OUT, FILL IN and FAX this order form to Fax: 1(847)577-7045. You can also Mail this form with payment to the above address.
All Shipments are made through UPS and cannot be sent to a Post Office Box.
| SHIP
TO: (print
clearly)
Name: ______________________________ (c/o) Company:______________________ Address:________________________________________________________________ City:_____________________ST:___ Country:____________ Post/Zip Code:_______ (Required for possible confirmation) Phone Number:________________________________ (Optional) E-Mail Address:___________________________________ |
| Qty | Description/ Color | Unit Price | Total | ||||||||||
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Method of Payment (Circle One Type Only): (Checks to be made out to Natural Solutions Environmental,Inc.)
Visa:
MasterCard:
Amex:
Discover:
Company Check/Cashiers Check:
Card Number: ___________________________________ Exp. Date: _______ CVN#: _____
Name On Card and Address if Different from above: ________________________________
Signature:_______________________________________ Date:________________
| The CVN Number (Credit Card Verification Number) is an anti-fraud security feature to help verify that you are in possession of your credit card. For Visa, Mastercard and Discover, the 3 Digit CVN number is the printed number on the back of the card in the signature panel.(The Last 3 Digits). For American Express, the 4 Digit CVN number is printed on the front of the card above the card account number (The Last 4 Digits). The CVN Number is required for YOUR credit card protection and to process order. |  |
For your protection, DO NOT E-Mail Credit Card Numbers!
All information contained on this Form is Confidential and is NOT given out for ANY Purpose!
Web site Copyright(c) 1997 Natural Solutions Environmental, Inc. All Rights reserved
www.naturalsolutions1.com
