DAVE  CHAMBERS

5510 Ptolemy Way, Mira Loma, CA 91752

Telephone # 951-685-3252   FAX # 951-685-7896

Please sign and fax this completed form to 951-685-7896, my dedicated fax telephone line

I ___________________________________authorize Dave Chambers to debit my credit card for the purchase of a Pet Dryer System / Cat Dryer System for the purchase price of $489.95. If I am a California resident I will add 8 % CA State sales tax to the purchase price. Packing, insurance and shipping to US residents will be $50. For International or Canadian orders, I have contacted Dave Chambers by telephone or email and I have received a quote of $____ for shipment to my foreign address.

One Pet Dryer System / Cat Dryer System at $489.95 +

Shipping of $_____________( $50 US,  Canadian or International quoted amount via email) +

CA State tax (if applicable) of $42.88

For a total of $____________

Place "X" next to motor desired: ___ for 110 volt, ___ for 220 volt.

Type of card_____________ (Visa, MasterCard, or American Express only)

Card number________________

Expiration date of card______________

Card holder name __________________

My name and complete mailing address is _________________________________________________

______________________________________________________________________________________

Signature____________________________________________________PHONE____________________

Your credit card bill will reflect Ragnarok Cattery for this purchase.