PondSolutions.com
Please print and fill out this order form and
FAX it to us at: (248) 524-9059. You must include a
FAX or email address where we can reach you.
We will not include your credit card information on any correspondence.
Order Form
~ Please print clearly ~
| Please fill out the personal information below: | Please fill out this section if you want your products delivered to a DIFFERENT address: | ||
| Name: | Name: | ||
| Address: | Address: | ||
| City: | City: | ||
| State: | State: | ||
| Zip Code: | Zip Code: | ||
| Daytime Phone: | Daytime Phone: | ||
| Evening Phone: | Evening Phone: | ||
| FAX # : | |||
| Email Address: | |||
Credit Card Information:
| Payment Options Available: Visa, MasterCard, or Discover | |
| Credit Card: | |
| Credit Card #: | |
| Expiration Date: | |
| Name on Card: | |
| Address of card- holder if different than above: | City: State: Zip Code: |
| Signature: | |
Purchase Order:
| Product | Product Code | Quantity | Price | Total Price for Item(s) |
SUBTOTAL: |
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6% MI SALES TAX (IF APPLICABLE): |
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TOTAL, Plus S&H (not included): |
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