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Order Form

     
 

Now, for your convenience, there are four ways to place your order:

1) Print this form and fax it to:
(703)778-2585

2) You can mail it to:
POOLCENTER.com
Order Processing
5185 MacArthur Blvd.
Washington, DC 20016

3) You can call us at
877-POOLCTR(877-766-5287)

4) You can place your order online with our super secure sub-domain store.POOLCENTER.com

Quantity

Item#

Description of Item

Price

       
       
       
       
       
       
       
       

Total*

 

*Total does not reflect additional shipping charges. POOLCENTER.com uses FedEx for shipments.

BILLING INFORMATION:

Name: _____________________________________________________ Company: _________________________________________

Address: ______________________________________________________________________________________________________

City: _____________________________________________________________________ State: ______________ Zip: ____________

Phone (H): ______________________________________________ Phone (C): ____________________________________________

E-Mail Address*: ___________________________________________________ Fax: ___________________________________

* Note: email address needed to send order confirmation, receipt, and tracking information.

 

CREDIT CARD INFORMATION:

Method of Payment:   ___MasterCard   ___VISA   ___DISCOVER   ___AMEX

16 digits 16 digits 16 digits 15 digits

                               

Expiration Date: __________ CVV Code?: _________

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Name As It Appears On The Card: _______________________________________________________________________________

Signature: ____________________________________________________________________________________________________

 
 

CHECK INFORMATION:

Bank Name: _________________________________________________________ Type of Account: [   ] Checking [   ] Savings

Routing Number?: ______________________________________________________________________________________________

Account Number?: __________________________________ Please Re-Enter Account Number: ___________________________

 
 

SHIPPING INFORMATION:

[   ] Same as Billing Information

Recipient Name: __________________________________________________________ Phone: _____________________________

Street Address*: _______________________________________________________________________________________________

City: ___________________________________________________________________ State: _______________ Zip: _____________

* Note: We cannot ship to a P.O. Box, we must receive a physical address to be able to ship an order.

Illinois, New Jersey, Georgia, Texas, Kentucky, Nevada, North Carolina,
Florida, Connecticut, and Washington D.C. orders subject to sales tax.
All orders are subject to shipping charges.
Please allow 24-48 business hours for processing.

THANK YOU FOR YOUR ORDER!

 
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