Todd Salat Shots Order Form

When placing an order, please include the following information:

Quantity Product Name
(with shipping)
Total:   $

The Shipping charges will be combined whenever possible and you will be reimbursed.

Name on Card *
Credit Card # *
3 Digit Code on back *
Billing Address *
Billing City *
Billing State *
Billing Zip *
Day Phone *
Evening Phone *


Card type*
Shipping Same as Billing
Shipping Name
Shipping Address
Shipping City
Shipping State
Shipping Zip

* Required

Comments or "To "
for book personalization:

Sign up for the Salat Shots Mailing List
(Private, confidential, and never for sale)


ThanxSalat for your order
Call (907) 250-4711
to place a phone order.

or Print and Fax to:
(907) 333-3367

or Print and Mail to:

Todd Salat
645 G Street, Suite 100 #798
Anchorage, AK 99501