Please Print This Page and Fax it TO: (949) 661-2861
Back
Name:
_____________________________________________
Phone:
_____________________________________________
BILL TO ADDRESS
SHIP TO ADDRESS
Street:
_____________________________________________
Street:
_____________________________________________
City:
_____________________________________________
City:
_____________________________________________
State:
_____________________________________________
State:
_____________________________________________
Zip Code:
_____________________________________________
Zip Code:
_____________________________________________
Silicone Caps are $12.ºº each Plus Shipping & Handling
Silicone Caps are subject to puncturing from sharp objects.
Cap Number
Quantity
Cap Number
Quantity
1)________________
______
2)________________
______
3)________________
______
4)________________
______
5)________________
______
6)________________
______
7)________________
______
8)________________
______
9)________________
______
10)_______________
______
11)_______________
______
12)_______________
______
13)_______________
______
14)_______________
______
15)_______________
______
16)_______________
______
17)_______________
______
18)_______________
______
19)_______________
______
20)_______________
______
Payment Options: Please check the payment option of your choice and fill in the appropriate information. Thank you.
Check In the Mail Check # _________ Amount: $______.___
Please Make Checks Payable To: FaceFirst, Inc.
Mail To: FaceFirst, Inc., 26081 Ave. Aeropuerto #E, San Juan Capistrano, CA. 92675
Credit Card # _____________________________ Exp. Date: ___/___/_______
VISA MASTERCARD
Name as it appears on card: ________________________________
Signature: _______________________________
Problems Faxing, Please Call (949)443-9895 or E-mail Us at facefirst_inc@email.com