Timberline Live Pet Food Order Form

Please provide the following contact information:
* Required Field

*Name
Business Name
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Country
*Daytime Phone
Nighttime Phone
*E-mail

Please provide your customer account number (if known):

User Name

Would you like a catalog sent to you?

Yes No

Please provide the following ordering information:

QTY	DESCRIPTION

	BILLING	*Additional $5 charge for all E-Check Transactions
Payment Method	-payment type- VISA MasterCard American Express Discover Preapproved credit terms E-Check
Cardholder Name

	SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Preferred shipping method:

UPS Express
UPS Second Day

Priority Mail
D.H.L
No Preference

Questions or comments:

Would you like a call back from our customer service department? All new customers will receive a phone call verifying your account information.

Yes No

Do you have an existing account with us here at Timberline?

Yes No

**Please do not enter credit card information, if necessary you will be contacted by a customer service representative**

**All orders will be confirmed via email within 24 business hours**