SHAKA TIME HAWAII
Please print this form and fax to 808-945-0994
FAX FORM
SHIPPING INFORMATION:
BILLING INFORMATION:
NAME:________________________________________ NAME:______________________________________
ADDRESS:_____________________________________ ADDRESS:___________________________________
CITY:_________________________________________ CITY:________________________________________
STATE:______ ZIP CODE:________________________ STATE:______ ZIP CODE:______________________
PHONE:_______________________________________ PHONE:_____________________________________
CELL PHONE:__________________________________ CELL PHONE:________________________________
FAX:__________________________________________ FAX:________________________________________
E-MAIL:______________________________________ E-MAIL:_____________________________________
ORDER FORM
1- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
2- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
3- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
4- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
5- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
6- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
7- CODE:____________________________________ SIZE:________ COLOR_________________ QTY______
Add $3.00 for 2XL, $5.00 - 3X, $7.00 = 4X, $9.00 - 6X and $12.00 for 8XL.
SPECIAL INSTRUCTIONS:____________________________________________________________________
________________________________________________________________________________
NAME AS APPEAR ON CREDIT CARD:_________________________________________________________
PAYMENT TYPE: VISA_______ MC_______ DISCOVER_______ AMX_______CHECK #_________________
CREDIT CARD NUMBER: _____________________________________________________________________
EXPIRATION DATE:________________________________ NAME OF BANK___________________________
AVS # __________ the last 3 or 4 digits on the back of your Credit Card by your signature/AMX in front

PLEASE PRINT THIS FORM AND FAX TO: 808-945-0994

* After we received your order we will contact you via email or by phone to confirm the total amount that we will be charging to your Credit Card including shipping and handling fees.

Thank you for ordering with us.