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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

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This file will NOT be sent electronically