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Print this form out, complete it, and fax or mail it to us!
Fax Order Number: (850) 653-8064
Mailing Address:
Universal Water
P.O. Box 412
Apalachicola, FL 32329
Personal checks are accepted by mail.
Name_________________________________________________________
Address______________________________________________________
City_________________________________ State______ Zip________
Phone #________________________FAX #_________________________
E-Mail______________________________
Credit Card Type (check one):
Visa___ MasterCard___ Discover___ Amex___
Credit Card Number___________________________________________
Expiration Date (mm/yy)__________________
Signature____________________________________________________
Part # Description Quantity Unit
Ordered Price
_______ ______________________________ ______ _______
_______ ______________________________ ______ _______
_______ ______________________________ ______ _______
_______ ______________________________ ______ _______
_______ ______________________________ ______ _______
Subtotal _______
Florida Residents, Add 6% Sales Tax _______
Order Total _______
| Your order will ship
via UPS (U.S. Mail to HI and AK), usually the next business day
after receipt. If your e-mail address is provided, we will e-mail a
shipping confirmation with a UPS tracking number. |
Thanks for your order!
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