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WHOLESALE FORM

Fill out this form on your computer if you dont want to click the cart online, then click the button below to print.   Sign form before faxing or mailing.  Include a copy of your tax ID on initial order.

Bill to: Ship to: (If different than billing info.)
Company Name
Contact Name  
Bill to Address 

City  
 
State

Zip Code
Business Name  
Contact Name       
Ship to Address  

City  
 
State
 
Zip Code
Is this shipping to a residential address?     Yes               No
Phone
Fax 
e-mail address

    Item number/description.

Quantity 

Price EACH

Pay with (Check one)

  Check by mail      
If paying by credit card, 
Name on card

Business name

Card number  

Expiration date  (Mo./Year)
  
3 digit CVV code on back
Billing address on card


City
  
State
 
ZIP

Cardholder sign here>  X_____________________ I have read and agree to the terms and conditions of Cool Nauticals/Hot Tropicals Inc. imports web store. 
Fax orders to to
877-348-2296 
We will bill you card when we begin processing your shipment.

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