Pelican Marketing, LLC
P O Box 4143
West Hills, CA 91308-4143
USA
Toll Free Fax:(866) 883-0755
(Please type all information and then print this form or Email.)
Name
Address
City
State
Zip Code
Telephone number
Country
Email address
Card number
Expiration date
Customer signature
Items
QUANTITY
COST EACH
TOTAL
1.
2.
3.
4.
5.
6.
7.
8.
Sub-Total
$
Sales Tax: ( CA Customers Add 8.25% )
$
1st Class Mail
5-8 Days
By US Mail
$4.95
Shipping Charge Canada Only
4-6 Weeks
By US Mail
$7.00
Shipping International
6-8 Weeks
By US Mail
$16.00
Total
$
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