Order Form: PO# ____________ Date: _____________

Payments by Personal Checks Must Use This Form

To order by check:

Fill out the questionnaire at the bottom of the page. Print out the completed form on your printer.
Attach you check to this form in the area shown. Upon receipt of check, your order will be shipped.

Make checks payable to See-Bak, Inc. in U.S. Dollars.

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Attach Payment Check In This Area

Mail to:

See-Bak, Inc.
P.O. Box 128
New Britain, CT 06050

NOTE: For those that hesitate to send their credit card number over the internet on their purchase order. Type in confidential when asked for card number on the P.O. Form..

Submit your order as requested on the P.O. Form. Use this form to fax us your Credit Card. Number Card # ____________________ Exp.______ Zip. _______ Fax #(860) 224-9514

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Name: Date:
Address:
City: State: Zip:

Telephone:( ) Fax:( )
e- mail Address:

Signed: _____________________________ Date:

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Then Press "Submit" to Complete Your Order ***