Compact Impact - Fax & Mail Order Form

Fax & Mail Order Form

Please print this mail in / Fax order form to order your "Snaps On A Bottle" (or other products).

To send your order, please print out this order form, fill in your information and mail a copy to :

Compact-Impact.com
71 Broadway, Room 19C
New York, NY 10006 USA

We accept credit card, bank check or money order payment, please make you payment payable to Compact-Impact.com.

You can also fax us a copy to : 646.349.2695 for your credit card orders.

Order Information

Snaps On A Bottle $8.00	Quantity : _______	Item Total Amount : $_____________
Other Product _______________________	Quantity : _______	Item Total Amount : $_____________
Other Product _______________________	Quantity : _______	Item Total Amount : $_____________
Other Product _______________________	Quantity : _______	Item Total Amount : $_____________
		Product Total Amount : $___________
Shipping & Handling will be added to your charge		Please refer to www.usps.com for your shipping cost.

		Payment Total Amount : $____________

Please use "Other Product" area to add other products available on www.compact-impact.com and make sure to fill in the product name and pricing from www.compact-impact.com. Please fill in the quantity you want and add up your "Payment Total Amount" for making your payment. Please do not forget to complete your payment information or to include your check or money order payment with your order. We use United States Postal Service First Class Mail for shipping of all orders. For orders with multiple quantity or items a proper shipping cost may be added to your charge.

Customer Information

First Name : __________________________	Last Name : ___________________________
Billing Address
Street Address : ______________________________	City : _____________________________
State : ____________ Zip : ______________	Phone : ____________________
Shipping Information (If different from Billing Address)
First Name : __________________________	Last Name : ___________________________
Street Address : ______________________________	City : _____________________________
State : ____________ Zip : ______________
Credit Card (Amex, Master, Visa, Discover, Diners)	Number : ____________________________
Credit Card Expiration Date : ___________ (MMYY)

Additional Instruction/memo

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