Mountain View Adult Diaper Company:  Printable Fax Order Form

If you prefer not to use our secure online ordering, you may print and fill out this form by hand and fax it to: 1-866-686-8977, or you may mail it to:  

Mountain View Products, PO Box 222, Belfast  TN, 37019.

Tell us where to send the order:
Name: Street address: City/State:
Zip/Postal Code: Email:
Country:
specify your order here:
Product Description Product Number Price Quantity Total
         
         
         
         

Shipping is $8.75 for the First $100.00 & and additional $1.75 for each $100.00 thereafter.
We will ship the most economical method 
Sorry, no CODs.
International customers will need to e-mail for rates
Return Policy: NO RETURNS
Item Total:
  
Shipping & Handling  
Subtotal:
  
Tennessee residents add 8.25% sales tax:   
Amount Due:  
Credit Card Information
Master Card, Visa, AMEX, Discover (circle one)
Card #:
Expiration Date (mm/yy):                   Security Code on back of card:
Cardholder Signature:
Billing Address (if different from Shipping address):