MANUAL ORDER FORM

Don’t feel secure using our shopping cart? This form was designed for you to mail in or fax your order. Print this form in LANDSCAPE mode, fill it out and
Fax to (808) 842-3644 or mail to :

Aloha Molds, 330 Sand Island Acc. Rd. #109, Honolulu, HI 96819
Name_______________________________ Date________________________________
Address_____________________________ Credit Card #_________________________
Address_____________________________ Expiration :___________________________
City ________________________________ Name as on card:______________________
Zip Code____________________________ Signature:____________________________
Phone_______________________________ Last 3-digit code listed on front/back of your
credit card : ______________


Item #
Qty
Description
Price
Total
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Sub-Total
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Payments made by money order and cashiers check make payable to Aloha Molds. If paying by credit card, don't forget to complete credit card information. Payments made by money order and cashiers check, please include order form.

Sales Tax 4.167%
 ______________
Total