Undercover Condoms Printed Order Form
CALL: 1-800-893-9105 FAX: 614-921-9866 MAIL: Undercover Condoms 4265 Diplomacy Dr, Columbus, OH 43228 US
Are you a previous customer?        NO       YES - Enter your last order number (optional):
Your Billing Information
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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
                                    
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Expiration Date
                                                                      
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Your Order Information
Item Name / Description Pack Quantity (if applicable) Quantity Price (each) Total
         
         
         
         
         
Sales Tax (Ohio Residents add 6.75%):  
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Shipping Method And Cost:		    
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** 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.