Rodent Blaster Secure Order Form

Customer Info: (Where you want your order shipped to)

You must click this box to accept our terms and conditions.

First Name:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Email Address:

Order:

Rodent Blaster Part #

Description

Qty

Detonator Cord

Description

Qty

Hoses

Description

Qty

Trailer

Description

Yes / No

Payment:

Method:

Credit Card #

Expiration

3-4 Digit Security #

Name as it Appears On Card

( 800 ) Credit Card Customer Service Phone #

Billing Address:

Address:

City:

State:

Zip:

For Your Protection All Credit Card Orders:

All credit card orders need to have the 3 or 4 digit security number from the rear of your credit card (i.e.: 1234-1234-1234-1234 (999)
We only ship PayPal orders to a confirmed address
All credit card orders are shipped SIGNATURE REQUIRED for your protection.

Shipping:

Shipping Instructions:

Coupon Code

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