If you would prefer to use a cashiers check or money order and bypass using the web 
ordering all together, You can simply send us this order form with a cashiers check
or money order for the total amount and we will gladly handle the order for you. You
can also Fax this form to us at 1 (270)721-0073. No personal checks please!

CASHIERS CHECK AND MONEY ORDER/FAX FORM                     GERMJUICE.COM  C/O BLACK LIGHT WORLD
1.Fill out and print the following form. We do not ship to Outside the USA.
WE DO NOT ACCEPT PURCHASE ORDERS. ALL ORDERS SHIP GROUND SERVICE ONLY!
First Name: Last Name:
Company name:

Ship to Address:
Street: City: State:

Zip Code:

 Phone # Fax#

e-mail:  Fill out to receive your Tracking Number.

Billing address (Leave Blank if same as above)
Street: City: State:

Zip Code: Credit Card (Circle One):

Credit card # (If Applicable) Expiration date
Security Code Reverse side. Include all digits    American Express Security digits are on the front side of card 

By entering this information you authorize Black Light World to charge your credit card. PAYPAL*BLKLGTWORLD Will appear on your statement.

Selected item (s) :
  Qty           Item Name                                              Item #

Special Instructions or comments:

Subtotal amount:

Shipping:       Below rates are within the USA only! Alaska & Hawaii Rates May Vary.
The following rates apply to check, money orders, or faxed orders only for USA ONLY!  Please contact us via e-mail for shipping pricing tp Alaska or Hawaii.
$0.01-$50.00 dollars $8.95
$50.01-$100.00: $9.95
$100.01-$200.00: $12.95
$200.01-$300.00: $14.95
$300.01- Up: $17.95
ABOVE RATES ARE NOT FOR DISTRIBUTORS OR  DISCOUNTED PRICING. WEB PURCHASES ONLY.

Kentucky residents add 6.0% sales  tax

Grand Total:

Signature: Your Credit Card Will Show PAYPAL*BLKLGTWORLD
ATTN: GOVERNMENT ORDERS, TSA, DHS, PAYPAL*BLKLGTWORLD WILL SHOW ON YOUR CREDIT CARD STATEMENT. IF YOUR NOT ALLOWED TO MAKE PURCHASES USING PAYPAL PLEASE DO NOT! REMIT A CHECK WITH OUR ORDER FORM.  PAYPAL MUST SHOW ON YOUR STATEMENT/OUR NAME. IF A REFUND HAS TO BE MADE AND A RETURN IS CREATED WE WILL CHARGE A RESTOCK FEE OF 25%
PLEASE BE AWARE OF THIS TO AVOID ANY ISSUES.

2.Send form (be sure to include Cashiers Check or Money Order payable to BLACK LIGHT WORLD if applicable) to:
 GERMJUICE.COM C/O BLACK LIGHT WORLD 
PO Box 26
Cub Run, Ky 42729     Or Fax to Germjuice.com C/O BLACK LIGHT WORLD
Fax#(270)721-0073