Spa Cover Order Form

Call 800-333-9276 with the information below
Or complete the form, print and Fax to 800-897-6527

Step 1: Your Contact Information

Company (if applicable):

Name: 

Street Address: 

City, State, Zip: 

Phone:

Work Phone: 

Fax Number: 

Email Address:

Step 2: Select a shape

Step 3: Measurements
in inches - refer to diagrams

Step 4: Select a color

A "

D "

B "

E "

C "

F "

Options:

 3" Skirt (standard):  Yes   No

 Lock & Tie-Downs (standard):  Yes No

 2lb Density ($40 Upgrade):  Yes No

Comments:

Step 5: Payment (or you may give this information by phone after faxing your order)

Credit Card Number:

Card CVV Number:

The last 3 digits of security code located on back of card.
AMEX 4 digit located on front

Credit Card Expiration:

Cover Cost:

Shipping:

Residential Delivery Fee:

Options:

Total:

$179.00

Authorized Signature: ______________________________
I authorize use of my credit card and confirm the information above. I agree to the terms and conditions outlined on our web site and understand that spa covers are custom made special orders and are non-cancellable non-returnable after the order is placed.

Be sure to include your correct contact information as we may be contacting you to complete your order and get/confirm your payment information. We accept Visa, Mastercard, American Express and Discover cards. Please allow 7 to 28 days for delivery. Thank you.