RainSafe USA, Inc       Order Form
Please TYPE, PRINT, SIGN, and FAX a completed form to:     Fax 914-244-0445    
For your protection simply print, complete this form, and fax to the number above.
Cust ID
Date
Bill to
Ship to
Address
Address
City
City
State
Zip
State
Zip
Bus. Type
Contact
Phone
Fax
Phone
Fax
Name
  Special Instructions / PO#
Title
eMAIL
Specify Order Details Below
Quantity
 Item Description
Price
Total
RS1000 Single Umbrella Wrapper
345.00
Shipping Per Box
18.00
RS2000 Dual Umbrella Wrapper
595.00
Shipping Per Box
22.00
RS1000S Full Size  / 3000 Sleeves Per Box
125.00
Shipping Per Box
18.00
RS2000S: Half Size Sleeves / 3000 Sleeves Per Box
120.00
Shipping Per Box
12.00

Sales Tax

TOTAL
PAYMENT METHOD:           Visa     Master Card     Discover     Amex
Credit Card #
Exp Date

CVV #
Name
Billing Address
City

State

 Zip
Signature: