Utah Seaplane Adventures

PO Box 273 Pleasant Grove, Utah 94062
Fax Number 801-796-7179
Email steven_19515@msn.com


Customer Order Form


Please print out and use the order form below when ordering and paying using a check, money order, cashier's check or a credit card when you do not want to use the PayPal Check-Out Service provided on the Website.

(To expedite your order and minimize errors it is suggested that you use the check-out shoping cart provided on the Website, up to the point where shipping is added. Print out the form and either send with payment or fax it with credit card information or use it as a guide to fill out the form below)

Name __________________________________________________________
Address __________________________________________________________
City, State, Zip____________________________________ , _______ , ____________
SHIPPING Address__________________________________________________________
(if different) __________________________________________________________
Phone: Home (_____) - ______ - ________ Work (_____) - ______ - _________
Fax # (_____) - ______ - ________ Mobile (_____) - ______ - _________
E-mail Address: __________________________________________________________
Payment: Personal or business check ______ ; Money order or certified check _____
Credit Card: Visa ____ MC ____ Diners ____ Discover ____ AMEX ____
Card # _________________________________ Exp. Date __________
Name on the Card ___________________________________________
BILLING Address Name ______________________ Street _________________________
of Credit Card City ________________________ State ________ Zip _____________

Catalog #Description & ConditionAmount
   
   
   
   
   
   
   
   
   
   
Shipping Rates - Continental US:
(Might be best to use calculated shipping from website shopping cart)
--- $10 for orders under $100,
--- $12 for orders totaling $100 up to $500
--- $15 for orders over $500
AK, HI, International orders: contact us for rates.
Sub-total  
Utah Residents: 6.5% Sales Tax  
Shipping & Insurance  
TOTAL AMOUNT  

Signature ________________________________________________ Date __________________

Special Instructions (if any): ___________________________________________________