Order Form

Order Form
The only safety device available for your mailbox

Order / Credit Card Form
1. Fill out completely WHILE ON LINE
2. Print this page (right mouse click)
3. Fax us your order 253-276-7592
or
Mail order form to:
RotoBox
4101 Edwards Mill Rd
Raleigh, NC 27612
Fastest:
Order by calling
919-788-0592
1-888-444-8439 Pin 4386 Toll Free
We can handle most orders with a quick phone call

* Required	*Billing Information*
Company Name
*First Name
*Last Name
*Address 1
Address 2
*City
*State
*Zip Code
*Phone
FAX
*E-mail
	Shipping address is the same a above
	Ship to address if different from above:
*Name:
*Address:
Address 2
*City:
*St:
*Zip
	Credit Card Payment Information
*Credit Card
*Name on Card
*Card Number
*Expiration Date	(mm/yyyy)

QTY		Price	Ext. Price

	NC 6.75% Sales Tax ($2.09)
	Shipping (USA)
	Total
*Signature	_______________________________________________________
YOUR INFORMATION IS NEVER SHARED OR SOLD

In the street again
Never again fear the traffic getting your mail!

We accept a major credit cards.

RotoBox, Inc. © 2006-2007
a subsidiary of RCR Imaging Products
Disclaimer: Customer/user holds harmless, Rotobox, Inc., its owners, employees, families, etc. from any injuries arising from the placement, and/or use of the Rotobox kit.