
HOW TO ORDER
NAME
COMPANY (if applicable)
PHYSICAL ADDRESS
CITY
STATE
ZIP CODE or POSTAL CODE
COUNTRY
PHONE NUMBER
FAX NUMBER
E-MAIL
INDICATE THE BAKUP BACKREST MODEL(s) that you wish to purchase:
When you have all information completed, you may place your order by
We accept VISA, MASTERCARD, AMERICAN EXPRESS, CASHIER’S CHECKS, MONEY ORDERS, PERSONAL CHECKS (allow time to clear).
PLEASE PRINT OR SAVE A COPY OF THIS ORDER AS WE WILL GIVE YOU A CONFIRMATION NUMBER.
THANK YOU FOR YOUR ORDER!
(please list MODEL and QUANTITY of each)
Using one of the 3 methods below:
985.758.5558
FAX YOUR ORDER TO:
985.758.5551