CUSTOMER INFORMATION
Print & Fax to: 303.295.1527

NAME:

ADDRESS:

CITY:                                                                       STATE:                                         ZIP:

PHONE:                                                             WK/CELL/FAX:


PAYMENT INFORMATION

VISA/MC #                                                                                 EXP:                               CVV #

Use Your Personal or Business Checking Account
Check Form

Name on Checking Account:                                                             Bank Name:

Bank Address:                                                             Bank City:

Bank State:                     Bank Zip:                               Bank Phone:



Routing Number:                                                             Account Number:                                              Ck #:

Deposit $:                                                             Balance $:


QTY. Accessories Size/Model Description TOTAL
        $
        $
        $
        $
NOTICE: NO REFUNDS, ALL SALES FINAL LuxSauna, Inc. does not install saunas or electrical under any circumstance. Deposit is non-refundable.

Customer Signature:
OK X ___________________________________
Date _________________

Received:
OK X ___________________________________
Date _________________ 		Subtotal 
Tax 
Total 
Freight 
$ TOTAL 
Down Payment
Non-Refundable