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Order
by Fax:
Please
fill the following Order & Shipping
information form.
Calculate
total amount
(product + freight) add sales taxes only if in Colorado
Fax
the completed Order
& Shipping information
form to:
Juniper
Enterprises
Fax :
1 970 923 6885
1711
Juniper Hill Road
Aspen, CO. 81611 USA
Order
& Shipping information form : Secret
Orgasm
* Are required fields
Ship to:
*
Name
___________________________________________________________________
* Shipping Address
___________________________________________________________________
* City
___________________________________________________________________
* Zip code
* State
* Country
___________________I__________________I_____________________________
Phone
Fax
Email
_____________________I__________________I___________________________
Bill to: (If different)
Name
or Company
___________________________________________________________________
Address
___________________________________________________________________
* City
___________________________________________________________________
Zip code
State
Country
___________________I________________I________________________________
Product :
*
Product name
* Product Price |
||
| * Shipment option please add | ||
|
US Ground $ 7 US 2nd day or Canada standard $ 12 Europe standard $ 25 All other countries $ 29 |
______________ | |
| Tax
(Colorado resident please add 5.4 % of the price) |
______________ |
|
| * Total | __________ | |
Credit Card: Visa - MasterCard - American Express Discover
* Credit Card Number
* Expiration date
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Comment
:
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Please fax the completed form to 1 970 923 6885
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