hookah at SouthSmoke.com Order 24 hours a day www.southsmoke.com
Order by phone 1.888.577.6653 Fax 305.402.2300
BILL TO SHIP TO(if different from "Bill To")
NAME NAME
ADDRESS ADDRESS
CITY CITY
STATE ZIP STATE ZIP
Please provide any discount or gift card code that you may have received below: We will need both your phone number and email address in case we have questions about your order.
DISCOUNT CODE PHONE EMAIL


ITEM# ITEM DESCRIPTION SIZE COLOR QTY UNIT PRICE TOTAL PRICE
METHOD OF PAYMENT
Please enclose your personal check, money order, or credit/debit card infomation.

We accept most major credit/debit cards:
___American Express ___Discover Card ___Visa ___MasterCard ___Visa Debit ___MasterCard Debit

CARD#__________________________________________

Expiration Date ____________

Authorized Signature (required)

________________________________________________
SUBTOTAL
ADD SALES TAX
For FL, NC shipping, please add
applicable local and state sales tax
SHIPPING CHARGES per address
For our current shipping charges, click here.
GRAND TOTAL
ORDER BY PHONE
Call Toll Free 1.888.577.6653		 FAX YOUR ORDER
Fax this order form to
305.402.2300		 MAIL-IN YOUR ORDER
Please contact SouthSmoke.com to first place your order via telephone.
THE SOUTHSMOKE.COM GUARANTEE
We guarantee your satisfaction! Our goal is to provide you with everything you need for your Hookah smoking pleasure. If you are not satisfied with your purchase, please contact us with 72 hours from the time of delivery and we will be glad to assist It's that simple!