Berry Aqua Paradise -- Off-Line Order Form

Aqua Paradise Off-Line Order Form

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To order, simply print out this form and fax it to us at (630) 579-1153, or mail it to the address below. We will send confirmation via email.

Item #1: Quantity ________ Size _______________ Color ________________
Description __________________________________________ Price $________________

Item #2: Quantity ________ Size _______________ Color ________________
Description __________________________________________ Price $________________

Item #3: Quantity ________ Size _______________ Color ________________
Description __________________________________________ Price $________________
Comments/Instructions:
_______________________________________________________________________________

_______________________________________________________________________________

Type of shipping (circle one): Ground | 2nd Day | Next Day (2nd Day, Next Day - US only)
(For shipping info, click here.)

Name _________________________ Phone Number (______) _______-_____________

Email Address ______________________________________________
Street ____________________________________ Apartment/Suite # ____________

City _____________________________ State/Province _______________________
(Note: IL residents pay 6.75% sales tax)

Country _______________________ Zip/Postal Code _________________

Credit Card (circle one): MC | Visa | Discover | American Express

Credit Card Number __________________________ Exp. Date _____/_____

Name on Card ___________________________ Signature __________________________

Berry Aqua Paradise 1620 Pebblewood Lane Suite 124 Naperville, IL 60563