TanZyr FAX or Mail Order Form
TanZyr * P.O. Box 4275 * Winter Park, Florida 32793
Phone: (407) 830-7660 * FAX: (702) 974-8474 / email: tanzyr@aol.com

Date: ______________________ Name: __________________________________________________________

Address: _________________________________________________________ Apt.: ______________________

City:__________________________________________ State:______________ Zip Code:___________________

Tele:_(_______)_________________________________E-mail:_________________________________________

Credit Card Info Please Circle One:    Mastercard     /     Visa
Name as it Appears On Card: ______________________________________________________________________

CC Number: ____________-_____________-______________-_____________ Exp. Date: _________/__________

Authorizing Signature:__________________________________________________________________________

ITEM #

DESCRIPTION

QTY

PRICE

TOTAL

         
         
         
         
         
         
         
         
         
         
     
Subtotal:
 
     
S&H (FREE*):
 
     
FL Residents must add 7% Sales Tax:
 
     
TOTAL:
 
US - Insured Shipping Deliv. Conf. Handling
International Shipping-Insured Airmail-FREE!
FREE S/H/I on standard orders!
*Add $15 for Express Mail

Money Orders and checks must be in U.S. Currency drawn on a U.S. bank.
** Questions? Please email tanzyr@aol.com **
THANKS SO MUCH FOR YOUR ORDER!