Waterbed Information

This file will NOT be sent electronically

ABC Waterbed Outlet Off-Line Call and Fax Form Toll-Free Fax: 1-877-420-2337

  Email:        

  Name:         

  Daytime Phone:

  Ship To:      

  Bill To:

Item#:
Qty:  
Size: 
Color:
Vinyl:
Price:
Descr:
         (Description)

Item#:
Qty:  
Size: 
Color:
Vinyl:
Price:
Descr:
         (Description)

   
     CC Type:         
     Credit Card No.: 
     Expiration Date: 
     Name on CC:

Please fill out this order form before calling in an order or faxing in an
order. It will help you be accurate and provide a record for your use.

ABC Waterbed Outlet
1819 While Lane
Norfolk, Virginia 23518

Phone In Orders Toll - Free

Toll-Free 1-877-420-2337
Monday through Friday
12 Noon to 6 PM E.S.T.

Fax 757-961-9271 any time

To print this form use the menu File Print command from your browser.

This file will NOT be sent electronically