Retail Order Form

Retail Order Form

Download Printable Order Form
Buy One Share One….Awareness Bugz Are Sold In Two’s But You Can Decide Which Two You Want To Buy. Two Butterflies Individually Packaged Are $12.99 Including The Donation To The Specified Charity. Please Buy Only In Sets Of Two.

Date: _______________________________________________________

Name: _______________________________________________________

Address: ____________________________________________________

City: _____________________ State: __________ Zip: __________

Telephone__________________Fax________________Cell___________

HIV Awareness Butterfly: Qty: ________ Total: $______________

Breast Cancer Awareness: Qty: ________ Total: $______________

Troop Support Awareness: Qty: ________ Total: $______________

Domestic Violence Aware: Qty: ________ Total: $______________

Ga. residents add tax: $_______________________________

Total: $__________________

Shipping and Handling to be added

We accept * Mastercard* Visa * American Express *

Card Number: ________________________________________________

Exp Date: ______________3 digit code__________________

Name of cardholder: _________________________________________

Address of cardholder: _____________________________________

City: _______________________ State: ________ Zip: __________

Shipping address if different from above:

Address: ____________________________________________________

City: _______________________ State: ________ Zip: __________

I authorize the above transaction: __________________________


PLEASE FAX YOUR ORDER TO: 1-866 269 6290

Credit card will not be charged until the order is ready for shipment. Please allow ten days for receipt of order. SHIPPING AND HANDLING CHARGES WILL BE ADDED.

ORDER WILL BE SENT USPS. RUSH ORDERS $10.00 ADDITIONAL CHARGE PER ORDER.



For questions concerning your order please email orders@bugz.com

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