California Blackworm CO.
Credit Card Purchase Agreement
Complete this form in full and CLICK the submit button at the bottom. Then email to firstname.lastname@example.org what you would like to order. In the event you cannot use the submit button below, you can print it, fill it out and fax to 559-291-0601 or copy and paste it and email to email@example.com Then email direct to firstname.lastname@example.org what you would like to order. We must have this form on file in for purchases to be made.