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----- VanishMyBumps.com -----
Use this form to Fax or Mail your order to VanishMyBumps.com
FAX TO:	801-880-1692				MAIL TO:	VanishMyBumps.com
						350 East Court St.
						Doylestown, PA 18901-9456
ORDERED BY:		NAME __________________________________
		ADDRESS ____________________________________
			____________________________________
		CITY _____________________			STATE ________		ZIP _________
SHIP TO:	Fill out only if the name and/or address is different than above.
		NAME __________________________________
		ADDRESS ____________________________________
			____________________________________
		CITY _____________________			STATE ________		ZIP _________
ITEMS ORDERED:
	Item Name				Quantity	Price	Total Amount
	PFB Vanish					$20.95	$ _________
SHIPPING & HANDLING CHARGES:
Check mark your shipping choice below and add the cost at right:							$ _________
___ USPS 1st Class Mail 3-6 business days - Within the USA only
(add $4.98 for the 1st item plus $1 for each additional item ordered)
___ USPS Priority Mail 1-3 business days - Within the USA only
(add $6.85 for the 1st item plus $1 for each additional item ordered)
___ USPS Express Mail *next business day - Within the USA only
* for orders received by 9 am EST
(add $20.95 for the 1st item plus $1 for each additional item ordered)
___ USPS Global - Canada
(add $7.98 for the 1st item plus $2 for each additional item ordered)
___ USPS Global - Mexico
(add $7.98 for the 1st item plus $2 for each additional item ordered)
___ USPS Global - All other International destinations
(add $8.98 for the 1st item plus $2 for each additional item ordered)
				THANK YOU		TOTAL	$ _________
METHOD OF PAYMENT
1. PAYMENT BY CREDIT CARD FOR FAX IN AND MAIL IN ORDERS
	Please Charge To:		___ Visa	___  MasterCard
	|   |   |	|   |   |	|   |   |	|   |   |	Card expiration date_________			CV2 code_____
	Signature_________________________________					Today's date____________
2. PAYMENT BY CHECK OR MONEY ORDER FOR MAIL IN ORDERS ONLY
	___Check         ___Money Order        PAYABLE TO "VanishMyBumps.com"
CONTACT INFORMATION
	Day Phone		( ____ )_______________			We'll contact you if we have
	Home Phone		( ____ )_______________			a question about your order.
	E-mail Address		_____________________
May we e-mail you special offers & updates from VanishMyBumps.com: ____ Yes      ____ No
YOUR SATISFACTION IS GUARANTEED OR YOUR MONEY BACK