Order 24 hours a day www.southsmoke.com Order by phone 1.888.577.6653 ? Fax 305.402.2300
BILL TO
SHIP TO(if different from "Bill To")
NAME
NAME
ADDRESS
ADDRESS
CITY
CITY
STATE ZIP
STATE ZIP
Please provide any discount or gift card code that you may have received below:
We will need both your phone number and email address in case we have questions about your order.
DISCOUNT CODE
PHONE EMAIL
ITEM#
ITEM DESCRIPTION
SIZE
COLOR
QTY
UNIT PRICE
TOTAL PRICE
METHOD OF PAYMENT Please enclose your personal check, money order, or credit/debit card infomation.
We accept most major credit/debit cards: ___American Express ___Discover Card ___Visa ___MasterCard ___Visa Debit ___MasterCard Debit
CARD#__________________________________________
Expiration Date ____________
Authorized Signature (required)
________________________________________________
SUBTOTAL
ADD SALES TAX For CO, FL, NC, NV shipping, please add applicable local and state sales tax
SHIPPING CHARGES per address For our current shipping charges, click here.
GRAND TOTAL
ORDER BY PHONE Call Toll Free 1.888.577.6653
FAX YOUR ORDER Fax this order form to 305.402.2300
MAIL-IN YOUR ORDER Please contact SouthSmoke.com to first place your order via telephone.
THE SOUTHSMOKE.COM GUARANTEE We guarantee your satisfaction! Our goal is to provide you with everything you need for your Hookah smoking pleasure. If you are not satisfied with your purchase, please contact us with 72 hours from the time of delivery and we will be glad to assist It's that simple!
