Martike Products Fax/Mail-In Order Form
| Complete the information and: | |
| Fax it to: | Or send by mail to: |
| (619) 262-0550 |
Martike Products Order Processing 5455 Market Street San Diego, CA 92114-2297 |
Name: _____________________________________________________________________(Please Print)
Address*: __________________________________________________________________
Address*: __________________________________________________________________
City: __________________________________________ State: ______ Zip: _____________
Daytime Telephone*: (_____) ______-_________ Fax: (_____) ______-_________
Email Address: ______________________________________________________________
Card Holder Name: ___________________________________________________________________
Payment by: ____Check ___ MasterCard ___Visa ___American Express
Credit Card #: _____________________________________________Exp:______________
Signature: ___________________________________________________________________
| Quantity | Product | Total |
| LG-2 Pillows @ ($39.95 each): | $ | |
| LG-V Pillows @ ($39.95 each): | $ | |
| Subtotal: | $ | |
| CA Tax @ 7.75% (if applicable): | $ | |
| Shipping**: | $ | |
| Order Total: | $ | |
*Orders in the continental U.S. are shipped by UPS Ground Track. Address must
be a street address and daytime phone number must be included.
Sorry, we cannot
ship outside the continental U.S.
**Continental US shipping costs are $9.10 for the first product and $2.50 for each product thereafter.
Contact us at 800-995-8865, email us info@synektics.com or Fax us at 619-262-0550 with any questions. We also supply small travel or child sized pillows and large king sized pillows. Call with inquiries.
Health care professionals - please call Terrie in commercial sales support for volume rates.