Payment by Fax or Mail
OR, click here to order online
 1. Fill out the form below and print
2. Mail or fax the form with credit card payment or check to the address or fax on the right. Make check payable to Pacifeeder.

(we accept checks and money orders only).
 Mailing Address:
Pacifeeder
21520 Yorba Linda Blvd., Suite G-458
Yorba Linda, CA 92887

Fax form to:
714-692-0182

Pacifeeder® Order Form

First Name:

Last Name:

Street Address:

City:

State/Province:

Postal Code:

Country:

Where did you hear about us?

Other:
Daytime Phone:

Fax Number:

E-mail Address:

Credit Card

Credit Card Number:

Expiration Date:

Pacifeeder
 Quantity
 Description
 Unit Price
 
 Pink Stars Pacifeeder
 $19.99
 
 Blue Fish Pacifeeder
 $19.99
 
 Yellow Dinosaur Pacifeeder
 $19.99

Shipping: Add $6.50 for shipping & handling for 1 bottle. Add $1 for each additional bottle. Product will ship by USPS Priority Mail. Please allow 3-5 business days for delivery.

Replacement Parts
Description Qty Price
3.00
Adapter 5.50
Long Tube 1.00
Flexi-Tube .80
3.70
.30
Flushing Disk .75
Washer .40
Short Tube .80
Smart Grip Velcro® Strap 4.00
Cleaning Brush 2.00
Subtotal:
Add 7.75% CA Tax
(CA orders only)
Shipping Charges $6.50 ea.
TOTAL



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Pacifeeder
21520 Yorba Linda Blvd., Suite G-458 Yorba Linda, CA 92887
Ph: 714-357-6777 | Fax: 714-692-0182

Copyright 1996-2004 Pacifeeder.com All rights reserved.

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Mothering Magazine

Pacifeeder gets a "Thumbs up" on ABC's "Home & Family Show"

Featured on Barbara Walters' "The View"