Balloons Unlimited of Wisconsin, Inc.

Print this page and use for Fax or Mail Order

PASSENGER NAME(S): (note...all tickets on order are normally placed in one "package". If you want separate "packages" for gift-giving, please indicate how tickets should be grouped)

#1_______________________________#2________________________________

#3_______________________________#4________________________________

#5_______________________________#6________________________________

PURCHASER INFO: (Ticket packages are normally mailed to the purchaser in a plain envelope. If they should be sent elsewhere, please tell us under "special instructions" below.)

Name:__________________________________________

Address:________________________________________

City, State, Zip:___________________________________________________

Weekday, Daytime Phone:____________________________

Charge Card: (Master, Visa)_______________________________________

Expiration Date:_________________3 digit code from back of card__________

Current Price per passenger:__________________Total:___________________

Special instructions:________________________________________________

_______________________________________________________________

_______________________________________________________________

Fax to: 262.593.2251

Mail to: W1341 Hwy. B Sullivan, WI 53178

Fax or Mail Orders will be mailed on the business day following the day they are received. Sorry, but we can't fax tickets because they are printed on a special form. We can fax you a confirmation that tickets were mailed if you wish.