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orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
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orderForm.deliveryDetails.billingAddress
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orderForm.noItems
Order Form  Item No. Product


 Price


 Price


Amount


Subtotal


 


Name ______________________________ Company ___________________________________________ Shipping Address __________________________________________________________________________ City ________________________________State _______ ZIP ____________ Country __________________ Phone Number ________________________________________Fax Number _________________________ E-mail __________________________________________________________________________________


 q Check enclosed (payable to “PHTA” in U.S. dollars) for: $_________________ (Call PHTA Member Services at 703.838.0083 ext. 301 for shipping and handling costs) q Charge to my: q MasterCard q Visa q AmEx q Discover


Card Number _____________________________________________________________ Exp. Date ___________________CVV# ____ Cardholder’s Name ______________________________________________________________________________________________ Signature ______________________________________________________________________________________________________


 1. Order Online at PHTA.org/Store 2. Mail with Payment: PHTA, 2111 Eisenhower Ave., Ste 500, Alexandria, VA 22314 3. Contact PHTA Member Services at memberservices@phta.org or call 703.838.0083 ext. 301 4. Fax: 703.549.0493


PHTA.org • Pool & Hot Tub Alliance • 703.838.0083


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ORDER FORM


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