To place your order by Fax or Mail,
Print out this form and FAX TO: (813) 662-5035
or Mail to: Dencities, PO Box 292911 Tampa, FL  33687
PLEASE NOTE: Prices subject to change without notice.
Make checks payable to Dencities
PLEASE REVIEW OUR RETURN POLICY
WE'RE SORRY, WE CANNOT SHIP TO P.O. BOXES 
Florida Customers  Only, please include 7% Sales Tax

QUAN.	ITEM NO.	DESCRIPTION	COLOR	PRICE (Ea.)
				$
				$
				$
				$
				$
				$
				$
				$
				$
			SUBTOTAL	$
			SHIPPING:	$
			FL SALES TAX	$
			TOTAL	$

Your Name:	_____________________________________________________________________
Address:	_____________________________________________________________________
City:	___________________________________State:___________Zip Code__________
Phone:	(               )   ________________________________________
E-Mail	_________________________________________________________________
CreditCard Select One	(Visa __) (MC __) CARD NUMBER ________-________-________-________ Expiration Date_________________________________

SIGNATURE___________________________________________________

Please tell us how you found The Den Mall ?_____________________________________

Special Instructions?______________________________________________________

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