TO PAY BY CHECK/MONEY ORDER by MAIL or FAX ORDER PAGE

Date:________________

PLEASE PRINT

Your Name:___________________________________________________

Ship to Address: _______________________________________________

City, State, Zip Code:____________________________________________

Payment Method:   p Check/M.O.   p Credit Card: _______________________________Type: _______ Expires:____________ Security Code:_________

Billing Address (if different from shipping address):_______________________________________________________________________________________

PLEASE MAKE CHECKS PAYABLE TO:    HomePlace Group, Inc.

TO PLACE YOUR ORDER:

Please print this form and fax it to or mail it along with payment. (You can FAX your check Toll Free to 1-877-875-5022 along with this order form.)  Please email us if you have any questions.  Please mail all orders to:

You can also email us your order and we will invoice you through PayPal, so you can use your credit card securely. Should you have question, please call 1-800-823-4233.