AnimalCulture.com Fax/Mail Order Form

Please print this form and complete all entries in black ink.

 

Fax to:            801-992-5621 (not toll free)

Mail to:           AnimalCulture.com

PO Box 832681

Miami, FL  33283-2681

 

Bill to (must be same as the credit card billing address):

      Name:  ______________________________________

      Address:  ___________________________________

      Apt/Suite:  _________________________________

      City/State/Zip:  ____________________________

      Email:  _____________________________________

      Telephone number:  __________________________

 

Ship to:                                            Same as billing address

Name:  ______________________________________

      Address:  ___________________________________

      Apt/Suite:  _________________________________

      City/State/Zip:  ____________________________

      Email:  _____________________________________

      Telephone number:  __________________________

     

Products Ordered:

Item Number:	Price	Quantity	Total price
		Total items:	Total cost of items:
		Coupon code / amount offà
Select and ADD Shipping:
2-7 Day Priority Mail/FedEx Ground or Similar (Orders over $39)  FREE		à	$0.00
2-7 Day Priority Mail/FedEx Ground or Similar (Orders under $39)  $4.99		à

 

Pay by Credit Card:   Visa  MasterCard   Discover     American Express

 

Credit Card Number:  _______________________________________________ 

 

Expiration Date:  _ _ / _ _ _ _ (Month/Year)

 

Security Code: _ _ _ _ (Visa, Master, Discover – 3 digits on back, AMEX – 4 digits on front)

 

Pay by Check or Money Order:                    Number: ______________

 

 

Signature:  ____________________________________                                                                   Date:  _________________

Please email Service@AnimalCulture.com with any questions.  Thank you for your order.