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Order by Mail
For a printable PDF version of this form click here. Print and fill out this form, enclose payment of $20.92 ($14.97 plus $5.95) and mail to: PatioDoorGuard c/o Consumer Benefit Plans Inc. 7304 Bryn Mawr Des Moines, IA 50322 Your Shipping Address: Name:_____________________________________________________ Address:___________________________________________________ City:______________________________ State:_____ Zip:___________ Phone Number:______________________ Email Address:______________________ Payment by Check or Money Order: Make payable to Consumer Benefit Plans, Inc. Payment by Credit Card: Check one:
Credit Card #__________________________ Expiration Date (month, year):_____________ Credit Card Billing Address (if different from shipping address): Name:_____________________________________________________ Address:___________________________________________________ City:______________________________ State:_____ Zip:___________ |
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For a printable PDF version of this form click here. Print and fill out this form, enclose payment of $20.92 ($14.97 plus $5.95) and mail to: PatioDoorGuard c/o Consumer Benefit Plans Inc. 7304 Bryn Mawr Des Moines, IA 50322 |
Visa
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