Order Form

We are not an e-commerce website.

Once you find the products you wish to purchase, either fill in the

form on-screen and print it off or print off our order form then fill it out.

Then, call us to place your order or send it to us.

We take VISA, MasterCard, & Discover, money orders and checks (2 week delay)

Please feel free to call us if you prefer to ask us for advice before placing an order.

Click Here for our Policies on: Returns - Freight Damage - Warranty

Date: 

Step 1

   Ship To:

Name:

UPS Delivery Address:

Mailing Address (if different):

City:

State:

Zip Code:

Phone Number:

E-Mail Address:

How Did You Hear About Us?

Do you need a new catalog?

Step 1.5 (if needed)

   Bill To:

Name:

Mailing Address (if different):

City:

State:

Zip Code:

Phone Number:

Step 2

   Method of Payment:

         Please Check One

Check:

Money Order:

   Credit Card

Visa:

MasterCard:

Discover:

Card Number:

Expiration Date:

3 Digit V Number (required):

Cardholder's Name (as it appears on card):

Step 3

   Your Order:

Step 4

   Shipping Charges

Self Reliance Resources, P.O. Box 392, Burlington, CO  80807

Phone: (719) 346-4663  -  9AM-6PM Fax: (719) 346-4663  -  Hours: 9AM-5PM (MT) Mon.-Fri.

home  ~  why should I prepare  ~  hot sales  ~  product directory  ~  catalog