Customer E-Mail
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ELITE Tanning Lamps
Category Product Selection Qty Total
Elite SELECT
Elite PLUS
Elite PINK
Elite ULTRA
HP Facial Bulb
Philips Starters
Sub-Total:
Shipping & Handling:*
Tax (WA 9.50%):
Grand Total:
Billing Information
First Name:* Same name as on your card
Middle Initial:
Last Name:*
Address Line 1:*
Address Line 2: Apt. or Suite No.
City:*
State:*
Postal Code:*
Phone:
Shipping Information
Same as billing info:
Yes No
Payment Information
Card Number:* No dashes or spaces please
Expiration Month:* From your card
Expiration Year:* From your card
CV Code* 3 or 4 digit code
Card Brand:*


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A1 Tanning Supply
Billing Address
Name on Card
Address
City, State, Zip:
Phone number:
email address:
Shipping Address
Name
Address
City, State, Zip:
Phone number:
Payment Information
Credit Card #:
Month
 Year
CVC
Expires
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24 HOUR ORDER FORM
Item Description
Price Each
Total
Qty