5614 S.W. 25th Street, Hollywood, FL 33023, Ph: 954-966-7329,
Fax: 954-966-3584
Website:
www.survivalproductsinc.com
Email: sales@survivalproductsinc.com
Fax Order Form
Directions: (1) Type info into blank fields, (2) Print it out, (3) Fax it.
BILL TO:
Name:
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Charge Card: (check one)
Visa
MasterCard
Amer.Exp.
Discover
Card Number:
Exp. Date:
Sec. Code:
Email:
Cell:
SHIP TO:
(if different from billing address) Tail # or Boat Name:
Name:
Company:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Qty.
Part Number
Description
Cost
Buy
Rent
Service
Total:
For PURCHASE:
Specify if needed by a particular trip date:
For RENTAL:
Date Needed:
*Approx. Return Date:
DELIVERY:
(check one)
UPS Ground
Next Day
Second Day
Third Day
Special Shipping Instructions:
Signature:__________________________________ Date:
Name:
Note: For Shipping back rentals or service work, call our Shipping Rep., Jeff Heidenreich at Freightquote.com.
Ph: 800-323-5441 x1732, Fax: 913-319-0635, Email:
jheidenreich@freightquote.com
for best price.
Please call (954-966-7329) or email us (sales@survivalproductsinc.com) to confirm order was received.