You may print this form and fax or mail it to:

Fan-Tastic Gifts
66 Colgate Heights, RT. 9 W
Bennington, VT 05201
Fax: 1-802-442-8845
Name: ________________________________
Company: ________________________
Email Address: ______________________________
Billing Address: ______________________________
City, State, Zip: ______________________________
Country: ______________________________
Credit Card: MastercardVisaAMEXDiscover (circle)
Name on Card: ________________________________
Card Number: _______________________ Expiration: ________
Daytime Phone: ______________ Evening Phone: ___________
Shipping will be added: 
GIFTS

Ship Gift To (Name of Recipient): ___________________________

Shipping Address: ___________________________

City, State, Zip: ___________________________		 Order Total
Your Order:
Item # Description Qty. Price
1. ________ _____________________________________________ ____ _________
2. ________ _____________________________________________ ____ _________
3. ________ _____________________________________________ ____ _________
4. ________ _____________________________________________ ____ _________
5. ________ _____________________________________________ ____ _________
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