fax 2 form

www.bug-guy.com
Order by FAX Form
Toll free fax line 1 866 344-7279
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Please provide the following information to complete your order
(please print and write clearly)

Must provide the following information below:

Your Information

Name: ________________________

Address:
______________________________

City, State, Zip
___________________________________

Phone:
________________________

Email:
______________________________

Shipping Information

(If different from above)

Name: ________________________

Address:
______________________________

City, State, Zip
___________________________________

Phone:
________________________

Credit Card Information

Visa MasterCard

On the back of your card,
locate the final 3 digit number

(if different from above)
Card Holder's Name:

Credit Card Number:

Expiration Date: Verification #:

__________________________

__________ __________

Card Holders Information

(if different from above)

Name: ________________________

Address:
______________________________

City, State, Zip
___________________________________

Phone:
________________________

You may also mail your order to: Bugaboo Pest Control 3217 NE 261 Ave, Camas, WA 98607