|
Kindly enclose your check or money order
payable to: "Tribute
Marketing"
. Then please
Mail form to:
Tribute Mktg. Attn: Lauren Cote, PO
Box 802, Attleboro, MA 02703 USA
| Name |
|
| Shipping Address |
|
| City, State, Zip |
|
| Telephone |
(If we have a question.)
Fax: |
| E-Mail |
(To send an order confirmation.) |
Your Privacy is assured. No third party will be given
access to this information by Tribute Mktg. Credit card information is
not retained by Tribute Marketing.
| Payment by: (circle) |
Personal Check # Money
Order Bank Check
Credit Card |
| Credit Card Number
|
__ __ __
__ __ __ __ __ __
__ __ __ __ __ __ __ |
| Name as appears on
card |
|
| Expiration date |
Authorized Signature X |
| 3 or 4 Digit Sec.
Code |
On back of
card find last 3 digits to the right of signature: __ __ __ |
| Billing address for
Card |
|
| City, State, Zip |
|
|
Quantity |
Item |
USD Price |
Total |
|
#W103 PottyMD Wet-Stop3
|
$ 64.95
Sale
$ 49.95 |
|
| ------- |
US Postal Service
/ Priority Mail + Free Delivery Confirmation
|
$ 5.95 |
5.95 |
| ------- |
Shipment to
Canada? Add $2.00 |
$ 2.00 |
|
|
TOTAL PAYMENT ENCLOSED
(or to be charged)
|
TOTAL |
|
|