Lighthound, Inc. Fax Order
                          Fax to:  +1 (866) 649-5834 or +1 (281) 404-9060

Name:____________________________________________

Billing Address:

_____________________________________________

_____________________________________________

_____________________________________________


Phone Number:________________________________

Shipping Address if different:

_____________________________________________

_____________________________________________

Fax Number (optional):__________________________

Email Address:_________________________________

Credit Card Type (circle one):

Visa     Master Card     American Express    Discover


Name on Card:_________________________________________


Credit Card Number:___________________________________

Exp Date:_________Credit card code:______
(CC code is the last 3 numbers on signature panel on back of the card or 4 printed digits on front of AmEx)

Notes:  We will add the appropriate shipping charge for this order based on the shipping charges reflected on our website.  Your credit card will not be charged unless everything is in stock and ready to ship.  In the event of a partial order we will email you.  If you do not include either an email address or phone number, this order will not be processed.

                           YOU MUST SIGN AT THE BOTTOM
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Signature:________________________________________