4628 S. Ward Way, Morrison, Colorado 80465

Phone: 303.978.0940 Fax: 303.973.2044 E-Mail: lifereef@denver.net

Order Form

NOTE: THIS IS NOT A SECURE SITE!
DO NOT send your credit card information from this page. We will contact you by phone to get this information. This applies to PayPal payments too.

(Though we accept PayPal we would like to reserve this for foreign orders only.)

DO NOT HIT YOUR "ENTER" KEY OTHERWISE THIS FORM WILL BE SENT INCOMPLETE. USE YOUR "TAB" KEY TO MOVE YOUR CURSOR. You may also print this form and fax it to 303-973-2044.

Name:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Email:
Payment: We will contact you for your card number or you may fax to:
303-973-2044
Availability: You have read the product availability schedule at http://www.lifereef.com/frame.html and by submitting this order form agree to wait for the particular item(s) should they be out of stock.

If you don't remember the part number just use a description.

Item Description Qty Cost Total
Comments:
 Subtotal
4.7% Colorado
Sales Tax.
Total

Shipping And Handling Will Be Added To The Total

Order cancellations are NOT accepted via email and must be called in.