Fax/Mail Order Form

FAX ORDER TO: 800-863-3801

Mail Order to:  1 Greenview Drive Carlsbad, CA 92009
Call Order In:  800-439-0334

Name:  _______________________________________________________________

Address:  _____________________________________________________________

City:______________________________  State:______________  Zip:____________

Official Newlywed Name Change Kit $29.95 each
(Shipping & Handling add $4.00)  (California Residents Add $2.45 Sales Tax)

Payment Choice:

Mail Payment (enclose payment) Make check payable to Kitbiz.

Mastercard #   ______________________________
Visa Card #   _______________________________
Discover Card #   ____________________________
American Express #   _________________________

Expiration Date  ____________
Name on Card  __________________________

We gladly ship gifts (we include a gift card identifying who it's from)

A Gift For:  ___________________________________________
Address:  ____________________________________________
From:  _______________________________________________