ORDER FORM

Shipping information:

Name:

Address:

City: State: Zip:

Phone:

Fax:

eMail:

Payment information:

Payment Method (check one): CHECK ENCLOSED VISA MASTERCARD

Name on Credit Card:

Credit Card Number:

Expiration Date:

Quantity:

Total at $10.00 each:

CA resident add sales tax:

Shipping and handling (US residents) add:

Total amount due:

INSTRUCTIONS: Complete the above form. You may then either press this button to send your order. Or you may print the completed form on your printer and fax or mail it to Ants Free at the following address. Please make sure that you have included your email address and telephone number on the form. Please allow 2 to 4 weeks for delivery.

Ants Free
11693 San Vicente Blvd. Suite 510
Los Angeles, CA 90049

Telephone: (310) 207-2340
Contact Us

To Reset the form press this button

Payment Method (check one): CHECK ENCLOSED VISA MASTERCARD
Name on Credit Card:
Credit Card Number:
Expiration Date:
Quantity:
Total at $10.00 each:
CA resident add sales tax:
Shipping and handling (US residents) add:
Total amount due: