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

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

This file will NOT be sent electronically