Balloonatics Fax-to-us Order Form

Please provide us with the following information:

Customer Information:

Customer Name:

Company Name:

Street Address:

Apt./Unit #:

City: State:

Postal Zip Code:

Telephone: Fax:

E-Mail:

Where Heard of Balloonatics:
___________________________________________________________________

Deliver To:

Name:

Company Name:

Street Address:

Apt./Unit #:

Cross Streets:

City: State:

Postal Zip Code:

Telephone: Fax:

E-Mail:

Delivery Date:

Message on Card:

___________________________________________________________________

Product Order Information:

1)     Quantity:       Item:
2)     Quantity:       Item:
3)     Quantity:       Item:
4)     Quantity:       Item:
5)     Quantity:       Item:
6)     Quantity:       Item:

Comments/Instructions:

__________________________________________________________________

Payment Information:

We will contact you to confirm your order and arrange for payment.   Thank you for your order.

__________________________________________________________________

Print out this application and fax it to us:


(Use the Print function from your browser if this button doesn't work with your system.)

Fax to: 408-866-8243

(10/99)

Call Us Today...    408-866-8206

180 Dillon Ave.  ~  Campbell, CA  95008   ~  Fax: 408-866-8243 

E-Mail: Info@BalloonaticsEvents.com

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