Order Form
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Please print this order form out and use it when placing an order. You can fax these things in to us if you would like, but if you do, please enlarge the copy of your ID so that it can be read easily. You may also just send them in to us, whichever you would like.
Let us know if you have any questions or if there is anything we can do for you. Please type or print legibly - do not abbreviate.

 

Firefox Information

PO Box 5366
Pocatello, ID. 83202

(208) 237-1976 voice or fax

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Personal Information

Full Name:     ______________________________________     Age:    __________

Address:         _______________________________________________________

City:    ____________________    State:     _________    Zip Code:    ____________

Country:     _________________________________________________________

Email Address:     ____________________________________________________

Home Phone :    _______________________    Current Date:    ________________

Business Name (if applicable):     ________________________________________

Business Phone:    ___________________________     Extension:    ____________

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Method of Payment

[  ] Money Order - amount - $ ________________

[  ] Personal Check - amount - $ ________________

[  ] Charge Card (please mark type of card below)

        [  ] Mastercard

        [  ] American Express

        [  ] Visa

        [  ] Discover

Card # ______________________________________

Date of Expiration ____ / ____

Cardholders name ____________________________

Cardholder Signature ___________________________

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Misc. Information (mark all that apply)

[  ] Identification enclosed (only if new customer)

[  ] Identification already on file

State Permit - [  ] Not required   [  ] On file   [   ] Enclosed

Federal Permit - [  ] Not required   [  ] On file   [   ] Enclosed

Shipping preference: We will ship according to your preference if we can. We always try to save you money on shipping.

[  ] UPS

[  ] US Mail

[  ] Best Way

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Buyer's statement & liability release - must be signed & dated

 

 

   I THE UNDERSIGNED CERTIFY THAT I HAVE READ, UNDERSTAND AND AGREE FULLY
WITHOUT RESERVATION TO SALES CONDITIONS AND LIABILITY RELEASE AS STATED
HEREIN AND THAT A) I AM 21 YEARS OF AGE OR OLDER, FULLY AND LEGALLY QUALIFIED
TO RECEIVE AND USE THE MERCHANDISE ORDERED; B) I FULLY UNDERSTAND THAT THE
MERCHANDISE ORDERED MAY BE DANGEROUS TO USE OR STORE AND I UNDERSTAND THE
NATURE, SAFETY PRECAUTIONS AND RISKS (TO HEALTH, OF STORAGE, USE OR OTHER) OF
MERCHANDISE ORDERED; C) I WILL KEEP ALL MERCHANDISE UNDER MY PERSONAL CONTROL;
D) I WILL USE AND STORE MERCHANDISE OUT OF REACH OF CHILDREN AT ALL TIMES AND
WITHIN LOCAL, STATE, AND FEDERAL LAWS; E) I UNDERSTAND AND AGREE THAT FIREFOX
ENTERPRISES INC.
, NOR ANY EMPLOYEE, AGENT OR ANY IN PART THEREOF EXTEND ANY
WARRANTIES EXPRESSED OR IMPLIED OR MAKE ANY STATEMENT OF USAGE; F) I FULLY,
WITHOUT RESERVATION OR CONDITION, AGREE TO ABSOLVE & HOLD HARMLESS AND
INDEMNIFY FIREFOX ENTERPRISES INC., ALL EMPLOYEES, AGENTS, OFFICERS OR ANY IN
PART THEREOF FROM ANY AND ALL INJURIES OR DAMAGES TO PERSONS OR PROPERTY
AND/OR CLAIMS, ALLEGED OR PROVEN RESULTING IN ANY WAY FROM THE PURCHASE, USE,
POSSESSION, DISTRIBUTION, SALE/RESALE, TRANSPORTATION, HANDLING AND/OR STORAGE
OF MERCHANDISE OR ITEMS AND SUBSTANCES MADE FROM SAME; G) I FURTHERMORE AGREE
TO RE-IMBURSE FIREFOX ENTERPRISES INC., OR ANY AGENT THEREOF FOR ANY AND ALL
COSTS, FEES OR EXPENSES INCURRED IN THE DEFENSE OF CLAIMS OR JUDGMENTS THAT MAY
ARISE AS A RESULT FROM THE PURCHASE, TRANSPORTATION, HANDLING, STORAGE,
SALE/RESALE AND/OR USE OF MERCHANDISE ORDERED.

I AGREE THAT ALL TERMS & CONDITIONS OF THIS STATEMENT AND SALE APPLY EQUALLY
TO ALL PURCHASES - PAST, PRESENT AND FUTURE AS WELL AS ORDERS CALLED IN BY
TELEPHONE OR BY FACSIMILE (FAX). I HAVE READ, UNDERSTAND AND AGREE FULLY
WITHOUT RESERVATION OR CONDITION TO ALL TERMS AND SALES CONDITIONS AS LISTED
HEREIN.

_

__________________________________________________________________________                     ____________________
                                                         Signature of Buyer                                                                                                Date

 

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Items Ordering

For faster order processing, we give you the option to list 2nd choices on any items for which
substitutions are acceptable. We will send your 1st choice if it is available. No substitutions
will be made unless you specifically request a 2nd choice item.

Qty              Choice 1        Choice 2        Description                                                                      Price
                     Stock #           Stock #
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
_____      _________     _________      ________________________________________     $_________
Minimum Merchandise order - $15.00  -                     
Merchandise Total  -                     
                      
Subtotal  -                     
Shipping Charges  -                     
($25.00 UPS) Hazardous Charge(s) -                     
$3.00 ($6.50 & $12.00 haz) UPS -or- $3.85 non hazmat or $5.50 ORM-D box US Mail - Box/Packaging Fee -                      
$12.00 or $14.00/box - DOT-E-8249 Exemption Packaging -                     
(6%) Idaho Residents Sales Tax -                     
Subtotal -                     
Order processing fee (all orders including quoted prices and sale items)                                                         + 3%                       
Any Credit or Balance due -                        
Total this order -                      

 

Firefox Enterprises Inc.
PO Box 2668
Pocatello, ID. 83204
(208)237-1976