Total Security, Inc.

1508 Miner Street

Des Plaines, IL 60016

FAX TO:

847 803-9022

Fax/Mail

Order Form

QUESTIONS?

PLEASE CALL CUSTOMER SERVICE AT

847 803-9001

In case we need to contact you about your order… 

All contact information is kept strictly confidential and is only used as needed to process your order. NO REFUNDS OR RETURNS Defective Items will be exchanged only...Thanks!

VISA____MC_____AMEX____DIS_____.

NAME ON CARD:_________________________________

CREDIT CARD #_________________________________

Exp:_____/______Signature:_____________________________

3 # V CODE ON BACK OF CREDIT CARD_______      _4 # AMEX ON FRONT_________

_Name:

_Name:

_Street:

_Street:

_City:

_City:

_{State:                            Country:                   Postal/Zip Code:}

_{State:                            Country:                   Postal/Zip Code:}

_QTY

_{Product Description}

_{Unit Price}

_{Total Price}