Fax Order
Please Fax this
 completed  form to:
FAX (205)-752-9601


613 - 17th Street
Tuscaloosa, Alabama 35401
Phone (205) - 752 - 7596

Please print this form, fill out necessary information and fax to us.
Quantity: Item Description: Cost: Subtotal:
       
       

Shipping charges can be found at the Shipping info page.


Alabama residents please add 8% sales tax.

Shipping   >

  

 Tax          >

  

Total        >

  
Bill to:
Name: Phone:
Card Type:                  Card Number: Expires:
Address:
 
City: State: Zip:
Shipping Info:                     Check here if same as above:  [   ]
* If Shipping to alternate address : You must call and inform your credit card company that you would like to set up an alternate shipping address on your account. We also need the credit card company phone number (from back of Credit Card) to confirm the alternate shipping address.
Sorry for the inconvenience, but this protects businesses and cardholders alike.
* Credit Card Company Telephone number :
Name: Phone:
Address:
 
City: State: Zip:

Use this space  for any special instructions.