Secure Order Form

Ordering Information

Please provide the following contact information:

First Name

Last Name

Street Address

Address Line 2

City

State/Province

Zip/Postal Code

Country

Telephone

E-mail

Please provide the following ordering information:

QTY
DESCRIPTION (cosmetic 5 pak, cleaning 5 pak or single stone)

(on single stone orders please specify cleaning or cosmetic)

Choose one of the following options: (shipping is included with ALL online orders)

Payment method:

Card or account number:

Expiration date:

Billing information will be sent encrypted through a 128-bit secure server.

Send check or money order to:
BK Pumice Products
186 North 100 West
Malad, ID 83252
(paypal users, use e-mail address: bkpumice@bkpumice.com)

Check
Visa
MasterCard
Money Order
Paypal

First Name
Last Name
Street Address
Address Line 2
City
State/Province
Zip/Postal Code
Country
Telephone
E-mail

QTY	DESCRIPTION (cosmetic 5 pak, cleaning 5 pak or single stone)



	(on single stone orders please specify cleaning or cosmetic)

Home D&L Webmasters.Copyright © 1999 [BK Pumice Products Inc]. All rights reserved. Revised: February 05, 2004

Home
D&L Webmasters.
Copyright © 1999 [BK Pumice Products Inc]. All rights reserved.
Revised: February 05, 2004