Shaka Time Hawaii Fax Order Form
Complete, Print and Fax this form to 808-537-5216
Delivery Information
Billing Information
NAME:________________________________________ NAME:_______________________________________
ADDRESS: _____________________________________ ADDRESS:___________________________________
CITY: _________________________________________ CITY:________________________________________
STATE: ______ ZIP CODE:_______________________ STATE:_______ ZIP CODE:_____________________
PHONE: _______________________________________ CELL PHONE: _______________________________
FAX: __________________________________________ E-MAIL: ____________________________________
ORDER FORM
Qty
SIZE
CODE
COLOR
COMMENTS
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
________ _________ _______________________ _____________________ _________________
SPECIAL INSTRUCTIONS:________________________________________________________________________
Shipping Information
What type of shipping would you prefer: USPS Priority Mail (7-10 days) ______ OR FEDEX (3-5 days) ______
Payment Information

Payment Type (circle): VISA - MC - DISC - AMX - JCB - Check# _________ Other: _______________________
Name on Credit Card: _____________________________________________ Exp Date: ____________________
CREDIT CARD NUMBER: _____________________________________________________ AVS # _____________
AVS are the last 3 digits on the back of your Credit Card by your signature or for AMX the 4 digits on the front

Your order will be processed within 1-3 days. You should receive an email with your invoice and information about your order. We will keep you updated on the process. Contact us with any questions at 808-545-3179.

Thank you for ordering with us.