Undercover Condoms Printed Order Form
CALL: 1-800-893-9105 FAX: 614-527-8565 MAIL: Undercover Condoms 2177 Westbelt Dr., Columbus, OH 43228 US
Are you a previous customer?        NO       YES - Enter your last order number (optional):
Your Billing Information
Please PRINT legibly
First Name: Last Name:
Street Address:
Street Address 2:
City: State/Province:
Postal Code: Country:
Primary Phone #: Evening Phone #:
E-mail Address:
Your Shipping Information (if different than above)
First Name: Last Name:
Street Address:
Street Address 2:
City: State/Province:
Postal Code: Country:

Your Payment Information
           
Visa MasterCard Discover American Express Check/Money Order Card Number On-File
                                    
Credit Card Number
    
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Expiration Date
                                                                      
Name on Card (as it appears on card)

I accept the above charge (Signature): X

Your Order Information
Item Name / Description Pack Quantity (if applicable) Quantity Price (each) Total
         
         
         
         
         
Sales Tax (Ohio Residents add 7.5%):  
Click Here to determine your shipping method and charge.
Shipping Method And Cost:
   
Order Total:  
** If you are paying by credit card, you may see a charge from 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.  Checks and Money Orders should be made payable to: PCPD, LLC
Please double-check that your order is complete and legible, especially the shipping address and phone number. Not providing a phone number or e-mail address could result in the delayment or unfulfillment of your order.