Fast-pack Order Form

Print this form and MAIL or FAX to:
226 SE Lee School Ave / Suite 36 / Lee, FL / 32059
Fax: (413) 460-8062 Ph: (866) 971-7201
www.Fast-Pack.com

* You must fill in all fields

E-mail	_____________________________
Full Name	_____________________________
St Address	_____________________________
City	_____________________________
State Zip Code	_____________________________
Country	_____________________________
Day Phone	_____________________________

Check here if same as billing information

Full Name	_____________________________
St Address	_____________________________
City	_____________________________
State Zip Code	_____________________________
Country	_____________________________
Day Phone	_____________________________
Other Phone	_____________________________

Credit Card Details
Credit Card # ____________________________________

Exp (mm/yy) _______ 3 or 4 Digit Security Code ______

Exact Name on Credit Card ________________________

Customer Signature ______________________________

	Quantity	Item Name	Item#	Price	Shipping	Total
1
2
3
4
5
6
7
8
9
10
Product Sub Total
Shipping SubTotal
FL Addresses add 7.5% Sales Tax or submit Florida Resale Certificate
Total

(sales tax on product only, not shipping)

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