When ordering by mail, if you will show your email address on the order form, I will send you confirmation upon receipt of your order. You will also be able to ask me about the progress of your order by going through the Contact Us link at the top of our web page, at any time. We feel it is important to keep you informed about your order. We are here to serve you.

Placing an order by fax or by mail, please copy, print,and complete the form below. Items with an asterisk (*) are required. Print legibly.

First name* ______________________________M.I. ______________

Last name *_______________________________________________

Shipping Address* __________________________________________

City* _________________________State* _______Zip* _____________

E-mail address ____________________________________________(optional)

Phone *____________________________________(Must give a contact number)

Charge Card * Visa____  Master Card ____ Discover____  Amer.Exp._____

Card number* ______________________________________________

Exp. date* ___________ Last three digits on back of card* ___________

Billing Address* _____________________________________________

City*______________________ State *__________ Zip* _____________

Items on order; show SKU #, Price, Color, Quantity, On all items ordered. Print an additional sheet if necessary;

SKU # ____________Unit Price _________ Color _______  Qty___  Total_______ 

SKU # ____________Unit Price _________ Color _______  Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty____Total_______ 

SKU # ____________Unit Price _________ Color _______  Qty____Total_______ 

SKU # ____________Unit Price _________ Color ________Qty___  Total_______ 

                                          Subtotal Price _____________

                                   Shipping Charges=      $9.95       (mail orders by UPS ground only)

                                               7% Ga. Tax __________   (Georgia residents only)

                                                Total Order __________

Signature* _________________________________________________

Date* ________________________

Pay by Check OR USPS Money Order-Include your check with this order form.

Make check or money order payable to;   "Jerald L. Penzo".

Products will be shipped as soon as your check has cleared the account. 

Mail your order to:

Stun Gun Self Defense, @ Great American Enterprise

104 Joann Drive

Brunswick, Georgia 31525

Fax your order to: 912-262-0603. Accepting Fax orders 24 hours. If busy, please try again.