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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.
Firefox Information PO Box 2668 (208) 237-1976 voice or fax * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Personal Information Full Name: ______________________________________ Age: __________ Address: _______________________________________________________ City: ____________________ State: _________ Zip Code: ____________ Country: _________________________________________________________ Email Address: ____________________________________________________ Home Phone : _______________________ Current Date: ________________ Business Name (if applicable): ________________________________________ Business Phone: ___________________________ Extension: ____________ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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 ___________________________ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Buyer's statement & liability release - must be signed & dated
I THE UNDERSIGNED CERTIFY THAT I HAVE READ, UNDERSTAND AND AGREE
FULLY I AGREE THAT ALL TERMS & CONDITIONS OF THIS STATEMENT AND SALE APPLY EQUALLY _ __________________________________________________________________________
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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Items Ordering For faster order processing, we give you the option to list 2nd choices on any
items for which
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Firefox Enterprises Inc. PO Box 2668 Pocatello, ID. 83204 (208)237-1976 |