Method of Payment
METHOD OF PAYMENT
Check/Money Order enclosed (Payable to: KidCo, Inc.)
VISA (13 or 16 digits)
Credit card account number
Signature of cardholder
Please print name of cardholder
Name
Street address
City
1013 Technology Way
Libertyville, IL 60048-5349
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Please do not send cash.
Mastercard (16 Digits)
State
Order amount
Shipping & handling
Total
Mo.
Yr.
Expiration date (required)
Date
Day time phone no.
Unit
Zip
$
$
$
5.00
17