| Relaxing Water Fountains Offline Order Form |
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| If you do not wish to order online, you may print and fill out this form to create your order. You can then fax or mail your order to us. |
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| Please print clearly. |
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| Your Name (company name if applicable) |
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| Streeet Address |
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State |
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Zip |
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| Daytime Phone (please include area code) |
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| e-mail address (we will send order status updates) |
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| Order Items |
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| Item # (SKU)* |
Description |
Price* |
Weight* |
Qty |
Ext. Price |
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| *Information can be found on item detail page |
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Subtotal |
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Sales Tax (PA Residents add 6% sales tax) |
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Free shipping for orders over $125 |
Shipping** |
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Total |
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| **Calculate the shipping rate by putting the items in your cart online, entering your shipping information and clicking next. |
| Payment Method (circle one): |
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Credit Card |
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Check |
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Money Order |
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| Credit Card Payment Info |
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| Card Type |
Card Number |
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Exp. Date |
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Master Card |
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Visa |
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American Express |
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Discover |
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| Signature (required) |
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| Fax #: (724) 318-9164 |
Address: |
Relaxing Water Fountains |
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P.O. Box 1676 |
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Cranberry Township, PA 16066-0676 |
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| Note: Orders paid by check will require additional processing time. |
| If paying by check or money order, please mail your payment along with your order |
