Personal Safety Plus Mail / FAX Order Form
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Quantity

Item #

Product Description

Price Each

Total
         
         
         
         
         
         
         
         
         
         
         
         
         
         

Shipping Address

Name:___________________________________________________________
 

Address:_________________________________________________________
 

City:________________________________State:_________Zip____________
 

Phone:___________________________________________________________

Subtotal

  

Please add $6.50 for shipping on orders less than $50.00

  

Please add 6.25% sales tax for Utah orders only.

  

Total

  
Method of Payment:  Make checks payable to Personal Safety Plus and allow 10 days for your check to clear.  If you are paying with a credit card we accept Visa, Mastercard, American Express and Discover.  If your credit card billing address is different than the above shipping address please provide the billing address on the back of this form.
Circle One:  Check    Money Order    Visa    Mastercard   American Express    Discover

Credit Card #____________________________________________Expiration Date___________

Signature:______________________________________________

Mail to:  Personal Safety Plus                                                        Phone Toll Free: 1-877-628-0601 or 435-628-0601
929 Sunset Blvd. #21 PMB156                                                       FAX:  435-652-4539
   St. George, UT 84770                                                                   www.personalsafetyplus.com
                                                                                                          info@personalsafetyplus.com