MAIL-IN / FAX FORM - 2 PAGES

Please fill out all necessary fields. Mail to: BandanaMan, PO Box 458, Crystal Bay NV 89402 or Fax to: (702) 869-8989

Please Double Check Your Information!
25% of all orders contain wrong information, particularly E-mail addresses, shipping address and wrong or incomplete credit card numbers.

*Designates Required Information

*SHIP TO (No PO or APO boxes):

*Full Name:_____________________________________________

Company:________________________________________________

*Address:_______________________________________________

_________________________________________________________

*City:__________________________________________________

*State/Province:________________________________________

*Zip/Postal Code:_________________

*Phone Day:_______________________________

Phone Night:________________________________

*Fax:__________________________________

*E-mail:_______________________________________________

 

*BILLING ADDRESS (if different than shipping):

Full Name:_____________________________________________

Company:________________________________________________

Address:_______________________________________________

_________________________________________________________

City:___________________________________________________

State/Province:________________________________________

Zip/Postal Code:_________________

 

*METHOD OF PAYMENT:
(Please note Nevada residents will have sales tax added)

Visa:_____ Mastercard:______

CC#___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

EX:___ ___ / ___ ___

Security code__ __ __ __ __ __ __

Money Order (Drawn on US$ Funds):_____
Cashier's Check/Bank Draft (Drawn on US$ Funds):_____

*SHIPPING METHOD (Our standard shipping method is FedEx):

FedEx Overnight:_____ FedEx 2nd Day:_____ FedEx 3rd Day:_____ FedEx Ground:_____

SPECIAL SHIPPING INSTRUCTIONS:_________________________________________

_________________________________________________________________________

 

 

 

*PRODUCT ORDER:
(Enter Quantity by Dozens. Example: 50 = 50 dozen)
OPEN CENTER BLANKS PAISLEYS SPECIALTY

Red Circular ______
Navy Circular _______
White Circular______
Black______
Navy Blue______
Red______
White______
Yellow (Bright)______
Purple _______
Forest green ________
Orange _________
Lt. Blue _________
Royal Blue ________
Lt. Pink __________
Natural(Organic) ______
Gray ______
Cocoa Brown ______
Tan ______
Gold _______
Black______
Cocoa Brown______
Hunter Green______
Light Blue______
Navy Blue______
Orange______
Pink______
Beige_______
Purple______
Red______
Royal Blue______
Silver______
White______

B&W Checkerboard______
Cowhide______
Multi Flag ________
Red Rodeo Cowboy______
Urban Camo______
Woodland Camo______
Pink Camo ________
Blue Camo ________
Digital Woodland Camo______
Desert Sand Camo ________
Digital Desert Camo ________

*Authorization Signature: __________________________________________________
(Necessary to begin processing of order. Must be signed by person authorized to place this order).

*Print Authorization Name: _______________________________________________

*RN#, Fed Tax ID, 501C Designation (please specify):___________________________________________________

*Date: ___________________________

All orders are confirmed by BandanaMan within 24 hours (except weekends).

PLEASE DOUBLE CHECK ALL INFORMATION! 

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