Fax Order Form
Print this page, fill it out completely and fax to 651-489-3232
or mail to:
pcPOOLS
2015 Rice Street,
Suite 50
St. Paul, MN 55113
Please include either a check made payable to
pcPOOLS or your credit card information.
|
Item # |
Description |
Price |
Qty |
Total |
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
|
Sales Tax 6.5%
Minnesota Res. Only |
|
|
Shipping & Handling |
|
|
Total |
|
Keycode: ___________
Personal Information
Name: ____________________________________
Address: ____________________________________
City:____________________________________
State:__________________
Zip: __________________
Phone Number:(____________)_______________________
Email Address: ____________________________________
How would you like to be contacted? _________________________________________
Payment Method (please check one)
Account # _____________________________________________
Expiration Date ______________
I own a/an (please check all that apply):
|
