SERVI PAK
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Easy Fax order Form for Coat Checks
Complete the online
form
below, print, and fax back to ServiPak
___ 1 set (200 pieces) :
$ 90.00 US funds
___ 2 sets ( 400 pieces): $ 160.00
US funds
___ 3 sets (600 pieces): $ 225.00
US funds
___ 4 sets (800 pieces): $ 280.00
US funds
___ 5 sets (1000 pieces): $ 325.00
US funds
Indicate preferred color:
___ Black/White _
___ Blue/White
Select payment method (Circle one):
Visa MasterCard
AMEX
Card number: _______________________________________
Expiry date on card: __________________________________
Name appearing on card: _______________________________
Authorized signature:
_________________________________
Complete shipping address - (Please
use block letters)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Telephone number:
____________________________
Email address:
________________________WE WILL CONFIRM YOUR ORDER VIA EMAIL
Fax back to: 888 303 1866
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Contact ServiPak: 1-800-759-9799