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 Bus. Address City State Zip Code	Business Name Contact Name Address City State Zip Code

Is this shipping to a residential address?	Yes No
Phone
Fax
e-mail address

Item number	Quantity	Color (For palm lamp verification only)

Pay with (Check one)

			Check by mail

If paying by credit card,
Name on card
Card number
Expiration date (Mo./Year)
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 770-919-7849 We will bill you card when we begin processing your shipment.