Undercover Condoms
4265 Diplomacy Drive
Columbus, OH 43228
| Undercover Condoms Bulk Order Form | |
| Instructions | |
|
Print this form if you wish to order in bulk by Fax or Mail.
Make sure your
entries are complete and clearly legible so that your order is
processed smoothly and your products arrive in a timely manner. Orders can
be submitted by faxing to: 614-921-9866, or by mail to: Undercover Condoms 4265 Diplomacy Drive Columbus, OH 43228 |
| Name and Shipping Information | |
| Name:___________________________________ | Are you a previous customer? (Y/N):_________ |
| Street Address:____________________________ | |
| Street Address:____________________________ | |
| City:______________________ State:_________ | Zip:__________________ |
| Phone(Day):__________________________ | Phone(Evening):_________________________ |
| Email:______________________________ |
| Your Order: | |||||||||
| Item Name/Description: | Quantity: | Price: | Total: | ||||||
| Caution Wear Black Ice (Thin) |  |
$99.95 | |
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| Caution Wear Iron Grip Snugger Fit | |
$99.95 | |
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| Caution Wear Slippery When Wet (Lubricated) | |
$59.95 | |
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| Caution Wear Speed Bumps (Ribbed) | |
$99.95 | |
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| Contempo Rough Rider Studded | |
$299.95 | |
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| Durex Enhanced Pleasure Lubricated | |
$159.95 | |
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| Durex Extra Sensitive | |
$159.95 | |
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| Durex Her Sensation | |
$159.95 | |
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| Durex High Sensation Ribbed | |
$159.95 | |
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| Durex Intense Sensation Lubricated Studded | |
$159.95 | |
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| Durex Maximum Love | |
$159.95 | |
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| Durex Natural Feeling (Non-Lubricated) | |
$159.95 | |
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| Durex Performax | |
$159.95 | |
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| Durex Rainbow Colors Lubricated | |
$159.95 | |
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| Durex Tropical (Colors & Scents) | |
$159.95 | |
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| Kimono Colors | |
$189.95 | |
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| Lifestyles Assorted Colors | |
$195.95 | |
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| Lifestyles Dual Pleasure (Xtra Pleasure) | |
$195.95 | |
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| Lifestyles Extra Strength | |
$195.95 | |
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| Lifestyles Kiss of Mint | |
$195.95 | |
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| LifeStyles Ribbed Pleasure (Vibraribbed) | |
$195.95 | |
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| Lifestyles Snugger Fit | |
$195.95 | |
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| Lifestyles Tuxedo | |
$195.95 | |
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| LifeStyles Ultra Lubricated | |
$195.95 | |
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| Lifestyles Ultra Sensitive Condoms | |
$195.95 | |
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| Lifestyles Ultra Sensitive Non-Lubricated | |
$195.95 | |
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| Lifestyles Warming Pleasure | |
$195.95 | |
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| Lifestyles XL | |
$195.95 | |
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| Okamoto Beyond Seven | |
$159.95 | |
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| Okamoto Beyond Seven Aloe | |
$159.95 | |
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| Okamoto Beyond Seven Studded | |
$159.95 | |
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| Okamoto Crown Assorted Colors | |
$159.95 | |
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| Okamoto Crown Skin Less Skin | |
$159.95 | |
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| Rain Personal Lubricants Assorted Flavors Singles | |
$429.95 | |
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| Reality Female Condom | |
$1,895.00 | |
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| Trojan ENZ Lubricated | |
$499.95 | |
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| Trojan ENZ Spermicidal Lubricated | |
$499.95 | |
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| Trojan MAGNUM Lubricated | |
$499.95 | |
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| Trojan MAGNUM Thin Lubricated | |
$499.95 | |
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| Trojan MAGNUM Warm Sensations Lubricant | |
$549.95 | |
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| Trojan Magnum XL Lubricated | |
$499.95 | |
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| Trojan Non-Lubricated | |
$349.95 | |
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| Trustex Assorted Colors Non-Lube | |
$249.95 | |
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| Trustex Assorted Flavors Lubricated | |
$249.95 | |
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| Trustex Assorted Flavors Non-lubricated | |
$249.95 | |
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| Trustex Banana Flavor Lubricated | |
$249.95 | |
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| Trustex Chocolate Flavor Lubricated | |
$249.95 | |
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| Trustex Cola Flavor Lubricated | |
$249.95 | |
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| Trustex Grape Flavor Lubricated | |
$249.95 | |
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| Trustex Mint Flavor Lubricated | |
$249.95 | |
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| Trustex Strawberry Flavor Lubricated | |
$249.95 | |
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| Trustex Vanilla Flavor Lubricated | |
$249.95 | |
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|
| Sub-total: (product total) | $____________ | |||
| Shipping and Handling: ($14.95/per case) - $14.95 x ______cases = | $____________ | |||
| Tax (Ohio residents add 6.75%) | $____________ | |||
| Total: | $____________ | |||
Payment Methods
Visa, MC, Discover, AM Ex, Check or Money Order (Payable to Undercover Condoms)
Please check one of the following:
Payment by Check / Money Order (Make payable to Undercover Condoms and mail to the
above address)
Payment by Credit Card - My card information is already on file
Payment by Credit Card - My card information is as follows
| Card Number:______________________________ | Expiration Date:__________ |
| Name appearing on card:_______________________________________________ |
| Card Billing Address (only if different from above): |
| Street Address:_____________________________________________________ |
| City, State Zip:_____________________________________________________ |
| I accept the above charge:__________________________________(Signature) |
| **If you are paying by credit card, you may see a charge to PCPD, LLC. This is the same as Undercover Condoms, and is used to ensure your privacy. This is also the label under which we ship all of our packages. |
Thank you for your order
Please double-check that your order is complete and legible, especially the shipping address and phone number.
Thanks again for choosing Undercover Condoms.
http://www.undercovercondoms.com/