Order by Mail: YupYup.com, Inc.              or         Fax: (631) 886-1740              or        Phone (631) 886-1740
                      PO Box 272
                      Wading River, NY 11792

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US Money Orders, and Personal Checks from US, UK, Canada, Bermuda, US Virgin Islands, Aruba, & Puerto Rico Accepted


Quantity____ x   129.95 = $_______
Add Shipping                    $_______              US Priority Mail Free(US Only) --- International/Global Priority Mail $5.95
                  
                        TOTAL _____________

Billing Information (If using your credit card, show exactly as it appears on the card)

Country:_________________________________________________

First Name:________________________ Last Name:________________________

Address 1: _____________________________________

Address 2: _____________________________________
(optional)
City: ______________________________

State: _____________________________Zip/Postal Code: ___________

If Shipping Address is different from above, please enter it below:

Country:_________________________________________________

First Name:________________________ Last Name:________________________

Address 1: _____________________________________

Address 2: _____________________________________
(optional)
City: ______________________________

State: _____________________________Zip/Postal Code: ___________


Please Check Credit Card Type: Visa_____     MasterCard_____     Amex _____      Discover_____

Credit Card Number:____________________________________

Expiration Date:_______________   Card Verification Number:_____ (usually found on the back of your card, the final 3 digit number)

eMail Address:_____________________________________________

Phone Number used for billing contact on this credit card:______ _____ ____________

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