Best Juicers Fax Order Form

Print, fill out and then
fax to 1-760-452-7734
We will confirm receipt of your fax order via e-mail within 24 hours


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Product/s you are ordering and price.

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Order total amount (CA residents add 8.25% sales tax)

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Credit Card Number

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Expiration Date


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Cardholder's Name - as it appears on credit card
CREDIT CARD BILLING ADDRESS:
Address where monthly
credit card statement is received

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Street Address

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City                         State                    Zip Code

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Home Telephone

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Business Telephone

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Email Address

SHIPPING ADDRESS:
(if different from above)

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Name

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Street Address

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City                              State                        Zip Code

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Telephone


I,  ____________________________ authorize Discount Vegetarian / Best Juicers to charge my credit card the
   
   Card Holder's Name
the amount of  $______________ and ship the order to the address listed above.


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Signature of Credit Card Holder


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Date