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, 284 Mountain View Road, Heiskell, TN, 37754.
If you have problems printing this form, click on the link below to download an Adobe PDF version of this form.
Click here for information on how to figure your shipping charges.
| 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 |
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Sorry, no CODs Return Policy: NO RETURNS |
Item
Total:
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Subtotal:
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| Tennessee residents add 8.25% sales tax: | ||||
| Amount Due: | ||||
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Credit
Card Information
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| Master Card, Visa, AMEX, Discover (circle one) | |
| Card #: | |
| Expiration Date (mm/yy): | |
| Cardholder Signature: | |
| Billing Address (if different from Shipping address): | |
