Rip n Roll | Mail Order Connection

Rip n Roll Mail Order Form

This is where you tell us all about you so we can send you the stuff you want. Easy enough? Simply fill out the form below. After you're done, print out the form and mail it to us along with a check or money order. Checks and Money Orders should be made payable to Rip n Roll and sent to:

Rip n Roll
P.O. Box 14301
Clearwater, FL 33766

For more info on our shipping methods click here.
To fax your orders, fax to 1-727-712-2346

Bill To: Name and address as it appears on your credit card statement
First Name:
Last Name:
Address:
City, State, Zip	Zip Code
Country:
Phone:
	phone number required for all credit card orders
E-mail:
	e-mail address required to send shipment confirmation
Ship To:	If different from Above
First Name:
Last Name:
Address:
City, State, Zip:	Zip Code
Country:
Gift Message or Special Instructions:

Method of Payment

Visa Mastercard American Express Check Money Order

Name on the card:

Card Number:
Expiration Date (MM/YY):

Billing on your credit card statement will be from Rip n Roll Inc.

Stuff you're buying Today

Item Description:

Quantity:

Item Description:

Quantity:

Item Description:

Quantity:

Item Description:		Quantity:
Item Description:		Quantity:

Shipping Method

First Class Mail FREE
Priority Mail $5.95
Next Day Air $18.95
International $16.50
(Outside the US)

Tax:

Add your county sales tax.
Florida residents only


Total Charge:
Items + Tax + Shipping

**If paying by check or money order: ALL CHECKS MUST BE IN U.S. DOLLARS. International customers must send International Money Orders only! Be aware that your order will be shipped as soon as the check has cleared. Credit card orders will be shipped the next business day.

Thank you for your Order