Sky Fantasy Fireworks Inc.

P.O.Box 188

Madison VA 22727

Phone 540-439-0959 Fax 540-948-7077


METHOD OF PAYMENT: (Check one)... (_) American Express... (_) MasterCard... (_) Visa...
NUMBER:_____________________________ EXPIRATION DATE:_____________________________

 (_) Money Order... (_) Cash (If you send cash in the mail, please insure your letter]
{_} Personal or Business check

SOLD TO:

 DATE: _________________________NAME:____________________________________

 ADDRESS: ______________________________________________________________________

 CITY: _________________________ STATE: _____ ZIP/POSTAL CODE: ___________

 PHONE: ________________________ FAX: ________________________


SHIP TO:

 NAME: _________________________ADDRESS:__________________________________

 ______________________________________________

 CITY: _________________________ STATE: _____ ZIP/POSTAL CODE: ___________

 PHONE: ________________________SPECIAL INSTRUCTIONS:_____________________

 Complete my order as follows:


ITEM NO. QTY. ITEM DESCRIPTION PRICE AMOUNT
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
    BOXING / PACKAGING CHARGE     $5.00
    Total this page .........  
    (Total from other pages) .........  
    Sub Total .........  
    VA Sales tax { if VA resident } .........  
   

{ call for quote or can be C.O.D.} Shipping Charge

   
    Total  .........  

 

Fax # 540-948-3353

Please fill out and either fax , phone ,mail or e-mail your order. We will call you with shipping costs or if paying by check you will pay for shipping charges COD plus a COD fee.Please do not forget that you must fill out and send back the Hold Harmless Agreement and send a photo copy of a picture ID before any orders can be processed Thank you