YOWZERS.COM ORDER FORM

For payment by credit card, check or money order (U.S funds only please), please print out this form and complete the information below. mail to:

yowzers.com
5610 Skyway
Paradise, CA 95969 USA

Or you may fax to: (530) 872-9501

DO NOT EMAIL CREDIT CARD INFORMATION (regular email is not secure)

Which payment method are you using (please check one)?

¤ MasterCard

¤ VISA

¤ CHECK

¤ MONEY ORDER

¤ OTHER

Credit Card Number:________________________________________

Expiration Date:___________________________________________

CCV2 Code# (3 digits on back of card):_________________________

Card Holder's Name:________________________________________

(as it appears on the card)

Street Address: ____________________________________________

________________________________________________________

(must be your credit card billing address)

City/State: ________________________________________________

Zip code: ____________

Phone:________________________________

Address to be shipped to (if different than above):

Street Address: ____________________________________________

City/State: ________________________________________________

Zip code: ____________

Phone:________________________________

Your email address:______________________@_________________

Item(s) description, Item #, Price:

(1) Item:_____________________________#__________Price:_____________

(2) Item:_____________________________#__________Price:_____________

(3) Item:_____________________________#__________Price:_____________

(4) Item:_____________________________#__________Price:_____________

(5) Item:_____________________________#__________Price:_____________

Total Amount:                                    ___________________

Coupon:                                        -     ___________________

7 1/4% sales tax (if CA res.):            ___________________

Shipping Amount:                             ___________________

USPS Insurance ($1.30 optional):   ___________________

Grand Total:                                       ___________________

CREDIT CARD AUTHORIZATION

Charge my credit card in the amount of:___________________

I understand that I am authorizing yowzers.com to charge my credit card for the purchase(s) I have made above.

Signature:__________________________________________ Date:________________

Amount charged on your credit card will show up on your statement as yowzers.com