ONLINE ORDER FORM

Please print this order form out and use it when placing an order. You can EMAIL these things in to us if you would like, but if you do, please enlarge the copy of your ID (first order only) so that it can be read easily. You may also just send them in to us, however, it is much faster to use email. Established customers may simply call your orders in. Let us know if you have any questions or if there is anything we can do for you.

Please type or print legibly - do not abbreviate

FIREFOX ENTERPRISES LLC
11612 N. NELSON
POCATELLO, IDAHO 83202

firefox-fx@hotmail.com
Order & Information Lines:
1 (208) 251-7415          1 (208) 909-8173


Personal Information - Please print


 Full Name_________________________________Age________Birth Date______________

 Ship To Address______________________________________________________________

 City_____________________________State___________________Zip Code_____________

 E-mail Address_______________________________________________________________

 Home Phone____________________________________Current Date___________________

 Business Name (if applicable)___________________________________________________

 Business Phone____________________________________Extension___________________

ORDER:


 Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

 Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

 Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

 Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

  Description______________________________Stock #______________Quantity________$ Total________

Method Of Payment:


[   ]  Money Order - Amount - $ ______________;      Personal Check - Amount $______________

Charge Card:  

[   ]   Mastercard - #_________________________Expiration__________Security Code/CVV_______

[   ]  American Express - #____________________Expiration__________Security Code/CVV_______

[   ]  Visa - #_______________________________Expiration__________Security Code/CVV_______

[   ]  Discover - #___________________________Expiration__________Security Code/CVV_______

[   ]  Other_________________________________________


Miscellaneous Information:
[   ]  Identification enclosed (only if new customer)    [   ]  Identification already on file
    State Permit - [   ] Not required   [   ] On file   [   ] Enclosed;
Federal Permit - [   ] Not required   [   ] On file   [   ] Enclosed

Buyer's statement & liability release - must be signed & dated


I, THE UNDERSIGNED, CERTIFY THAT I HAVE READ, UNDERSTAND AND AGREE FULLY, WITHOUT RESERVATION TO SALES CONDITIONS AND LIABILITY RELEASE AS STATED HEREIN AND THAT;

A)
I AM 21 YEARS OF AGE OR OLDER, FULLY AND LEGALLY QUALIFIED TO RECEIVE AND USE THE MERCHANDISE ORDERED;


B)
I FULLY UNDERSTAND THAT THE MERCHANDISE ORDERED MAY BE DANGEROUS TO USE OR STORE AND I UNDERSTAND THE NATURE, SAFETY PRECAUTIONS AND RISKS (TO HEALTH, OF STORAGE, USE OR OTHER) OF MERCHANDISE ORDERED;


C)
I WILL KEEP ALL MERCHANDISE UNDER MY PERSONAL CONTROL;

D)
I WILL USE AND STORE MERCHANDISE OUT OF REACH OF CHILDREN AT ALL TIMES AND WITHIN LOCAL, STATE, AND FEDERAL LAWS;


E)
I UNDERSTAND AND AGREE THAT FIREFOX ENTERPRISES LLC., NOR ANY EMPLOYEE, AGENT OR ANY IN PART THEREOF EXTEND ANY WARRANTIES EXPRESSED OR IMPLIED OR MAKE ANY STATEMENT OF USAGE;


F)
I FULLY, WITHOUT RESERVATION OR CONDITION, AGREE TO ABSOLVE & HOLD HARMLESS AND INDEMNIFY FIREFOX ENTERPRISES LLC., ALL EMPLOYEES, AGENTS, OFFICERS OR ANY INPART THEREOF FROM ANY AND ALL INJURIES OR DAMAGES TO PERSONS OR PROPERTY AND/OR CLAIMS, ALLEGED OR PROVEN RESULTING IN ANY WAY FROM THE PURCHASE, USE, POSSESSION, DISTRIBUTION, SALE/RESALE, TRANSPORTATION, HANDLING AND/OR STORAGE OF MERCHANDISE OR ITEMS AND SUBSTANCES MADE FROM SAME;

G) I FURTHERMORE AGREE TO RE-IMBURSE FIREFOX ENTERPRISES LLC., OR ANY AGENT THEREOF FOR ANY AND ALL COSTS, FEES OR EXPENSES INCURRED IN THE DEFENSE OF CLAIMS OR JUDGMENTS THAT MAY ARISE AS A RESULT FROM THE PURCHASE, TRANSPORTATION, HANDLING, STORAGE, SALE/RESALE AND/OR USE OF MERCHANDISE ORDERED.

I AGREE THAT ALL TERMS & CONDITIONS OF THIS STATEMENT AND SALE APPLY EQUALLY TO ALL PURCHASES, PAST, PRESENT AND FUTURE AS WELL AS ORDERS CALLED IN BY TELEPHONE OR BY EMAIL. I HAVE READ, UNDERSTAND AND AGREE FULLY WITHOUT RESERVATION OR CONDITION TO ALL TERMS AND SALES CONDITIONS AS LISTED HEREIN.

                Signature_______________________________________Date__________________

Because of it's complexity, we will figgure the shipping for you and email the total

THANK YOU