First name ----------------- (Always sent to the attention of your name) Last name ---------------- Daytime Phone ---------- Cell Phone ---------------- Ship to Company --------(Leave Blank if not sending to Company) Address (not a box number) City -------------------------- State ------------------------- Postal Zip Code ---------- Are Credit Card Statements Sent to this address? Yes or No Note: If Credit Card Statements are not sent to shipping address: Click Here to enter CC Address Country* ------------------- Models available - M200 - M300 - AC12 - IM20 - IM30 - T154 - T304 - S154 - MW1- MG3 - MK3 Ordering Model # -------- Quantity -------------------- We accept Master, Visa, Discover & Amex Credit Cards Credit Card # -------------- Expiration Date ----------- Card Verification # -------What is it? Processing Information--(For our office personnel, therefore no information needed here) Product Total (US) ----- $ The following three items are Optional for MightyKool Models Only: **(NOTE: Free Shipping/Handling if the Option is shipped with the original order.) Optional AC/DC Power -$AC/DC Convertor for all MightyKool Models **$29.00 Optional Water Holder -$Water Storage Container is used with the MW1 only **$12.00 Custom Cooling Pad Set $Cooling Pad Set of 2 for all MightyKool Models **$10.00 per set of 2 The Single Cooling Pad should be changed after 200 to 300 hours of use in your MightyKool to provide maximum cooling, therefore you may wish to consider ordering at least one Set with your order. **(NOTE: If ordering any or all options after the Original Order there is a S&H charge) Total Authorized (US) - $(Including Sales Tax for Arizona Customers Only) *E-Mail Address -----*Required --------