Todd Salat Shots Order Form

When placing an order, please include the following information:

Quantity Product Name
Size
Price
(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 *
E-Mail

*

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

* Required

Comments or "To "
for book personalization:

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

Print and Mail to:

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