Printable Fax or Mail Order Form for Biozone Air Purifiers

Printable Fax or Mail Order Form for Visa, MC, Discover, and AMEX

We also accept checks and money orders. Please contact us prior to mailing. Or you may order on our website with an eCheck.

Mail:

Fax:

(800)886-7248

Shipping and Contact Information
Name:		Phone ( ) -
Street:
City:	State:	Zip:	Country:
Email (for order confirmation):	Fax#:

Product Information
Qty	Item Description	Color (Black or White)	Price Each	Subtotal




Subtotal
Shipping FREE for orders over $33!
TOTAL

Billing Information
Check one:	VISA	MC	DISCOVER	AMEX
Credit Card Number: - - - Expires M/Y: /
CVV2 Code (3 digits on back of VISA, MC, DISC or 4 on front of AMEX):
Name on Card: Phone ( ) -

Credit Card Billing Address (where statements are mailed - check here ( ) if same as shipping address)
Street:
City:	State:	Zip:	Country:
Signature:		Date:

Thank you for your order and we hope you enjoy our air purifiers!