| Go Live Inc PO BOX 2464 PINELLAS PARK, FL 33780-2464 |
CD |
To Place An Order By Phone, Please Call TOLL FREE: 1-877-246-1286 Monday - Friday 7am - 5pm EST Fax: 1-(727) 329-8719 |
|
All orders
are Shipped in a Plain Box, with NO Mention of the Word Condoms
| ||
| Ship To: | Bill To: | |||||||
| Name | . | Name | . | |||||
| Address: | . | Address: | . | |||||
| . | . | . | ||||||
| City | . | City | . | |||||
| State | . | Zip | . | State | . | Zip | . | |
| Email Address: We will email you confirmation that we received your order. We will not sell or share your email address. |
||||||||
|
quantity: |
Item Name: ..... Example 12 Pack Durex Extra Sensitive |
Price
Each |
Total |
| . | . | $ | $ |
| . | . | $ | $ |
| . | . | $ | $ |
| . | . | $ | $ |
| . | . | $ | $ |
| . | . | $ | $ |
Coupon or Gift Card Code: _______________ |
- $ | ||
|
Plain
Box Shipping: ( Free Shipping 5-10 Days/ $0 -or- Priority Mail 2-3 Days/
$4.99) |
$ | ||
|
FL
Residents Only - add 7% Sales Tax |
$ | ||
|
Total |
$ | ||
| Payment Options: | If
your are paying by Check or Money Order: Please Make Payable to Go Live Inc. and send to: Go Live Inc PO BOX 2464 PINELLAS PARK, FL 33780-2464 Pay with Money Order For Same Day Shipping. Money Orders are Available at the Local Post Office * Note: There is a $25 Fee for Bounced Checkes, Personal Check are held for 10 days. |
|
| Credit Card: ( Visa MasterCard American Express Discover ) Money Order Check* | ||
| Card Number: | 3 Digit CCV Code ________ The last 3 digits on the back of your credit card where you sign your name |
|
| Expiration Date: | ||
| Card Holder Signature: X___________________________________________ | ||