Account Application Fax Form
Account Application Fax Form
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Name ____________________________________________ Tel: __________________________ Address _________________________________________________________________________ City, State, Zip Code _____________________________________________________________ Email address: ___________________________________________________________________ Credit Card number: _______________________________Exp. Date: ____________________ Signature___________________________________________________(for fax or mail applications) _______________I am 18 or older (initials, please). Under most circumstances, you can expect a same day response to your fax in the form of an email. Once your account has been confirmed and you have received your password, you may place an order at your convenience. Our Fax number is 541-298-5171. If you experience any difficulty in this process at any time, please call us at 541-296-3355. Our office hours are 10am-5:30pm, PDT, seven days a week. |