CHECK-SIX Order Form
Make sure you print your e-mail address VERY clearly.
Thank you.

Visa ,MasterCard, Discover, and American Express

only via

 Pay me securely with your Visa, MasterCard, Discover, or American Express card through PayPal!

To place an order, print this form out and complete. Then mail or FAX it to Check-Six. 
Check product page for shipping charges. Prices on the Web page are current, but are subject to change.
Name: _______________________________________________________________
Address: _____________________________________________________________
City: ________________________________  State: ______  Zip:_______________
Home Phone: _______________________  Work Phone: ____________________
E-mail address (required)______________________________________________
Stock Number
Product Description
Sub Total
California Residents add 8.25% sales tax
Shipping within USA Only
($15 per display, $5 per patch / item - Shipped via US Priority Mail- Is Insured -  NO International orders)


TOTAL (Personal Checks Must Clear Before Order Ships - May Take Up to Two Weeks.) 
Send this completed form plus a check or money order to:
PO Box 1797 

Martinez, CA 94553