Order form

WHOLESALE FORM

Fill out this form on your computer, 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)
CVV code on back...front if AMEX
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.