PURE BEACH Order Form

You can either pay with Mastercard or VISA !

Only for mail-in orders:
Please complete form, print out and mail to...
PURE BEACH, 4332 Inez Ave • Yucca Valley, CA 92284
Ph: 760.228.0118 • Fax: 760.228.0119
Within the US: Send payment in the form of a Cashiers Check or US Postal Money Order. Make Payable to PURE BEACH. (CA Residents please add 8.25% Sales Tax) Or use your Credit Card.
Foreign: Orders payable with international Money Orders. U.S.D./U.S. Bank. Or use your Credit Card

Shipping Rates: USA: 1-4 items $5.50, 5 or more items - $7.50 / Canada: 1-4 items $12.00 / 5 or more items: $ 18.00 / Other Countries: UPS shipping rates apply.

Please provide the following contact information:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please Order here:
(T-Shirt M-XL: US$ 18.-, XXL: US$ 21.-, Fleece: M-XL: US$ 36.-, XXL: US$ 39.-, Low Profile Embroidered Surf Hat: US$ 20.-, Sticker: US$ 2.- each )

Quan. Style No. Size Description (Design Name + T-shirt, Fleece, Hat or Sticker) Price
Credit card
Cardholder name
Card number
Expiration date
SHIPPING ADDRESS

same as above
Street address
Address (cont.)
Zip/Postal code
City
State/Province

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