You can print this form to use for mail order if you prefer.

CROOK BUSTERS         Self-Defense Products         P O Box 218         De Leon Springs, FL 32130         Phone 1-888-720-5ZAP         Fax 1-888-720-5729         www.crookbusters.com         e-mail: customerservice@crookbusters.com

www.crookbusters.com              DATE:_______________________

Name:	Name:
Ship To Address:	Billing Address:
Email Address:	Phone Number:

QUANTITY	MODEL NUMBER AND DESCRIPTION	UNIT PRICE	AMOUNT
SUBTOTAL
FLORIDA RESIDENTS MUST INCLUDE SALES TAX (6.50%)
THERE IS A $9.00 SHIPPING & HANDLING CHARGE FOR ORDERS LESS THAN $100.00
TOTAL DUE

Name on Credit Card__________________________             Check, Money Order, or Credit Card.

Credit Card Type_____________________________              Make all checks payable to: CROOK BUSTERS

CC#___________________________CCV _______             VISA, MasterCard, Discover, Amex

Expiration Date______________________________              THANK YOU FOR YOUR BUSINESS!

Signature___________________________________

It is the buyers responsibility, not the seller, to ascertain and obey all applicable local, state, and federal laws regarding the possession and use of any item offered by CROOK BUSTERS Self Defense Products. If you are unsure, please contact your local or state authorities. By placing an order, the buyer represents that all products purchased will be used in a lawful manner and that he/she is of legal age.

If you have any questions, call 1-888-720-5ZAP or e-mail: customerservice@crookbusters.com