| Toy Box Storage LLC. Customer Fax Form
 | 
                
                  | Instructions: To pay your 
                  storage fee by fax, print this form, then fill out the 
                  appropriate information below. Sections including your credit 
					card payment information need to be filled complete. Fax payments are to be submitted to 586.775.0567
 Note: Fields that 
                  are in bold are required.                       
                  Order Date:
 | 
                
                  | Bill To Information MUST BE CREDIT CARD MAILING 
                  ADDRESS
 | Ship To Information NOT CREDIT CARD ADDRESS
 | 
                
                  | - Unit Number: | - Unit Number: | 
                
                  | - First Name: 
 | - First Name: 
 | 
                
                  | - Last Name: 
 | - Last Name: 
 | 
                
                  | - Email Address: 
 | - Email Address: 
 | 
                
                  | - Address: 
 | - Address: 
 | 
                
                  | - City: 
 | - City: 
 | 
                
                  | - State: 
 | - State: 
 | 
                
                  | - Zip Code: 
 | - Zip Code: 
 | 
                
                  | - Phone Number: 
 | - Phone Number: 
 | 
                
                  | - Fax Number: 
 | - Fax Number: 
 | 
                
                  | Credit Card | 
                
                  | - Credit Card Circle One:      Master 
                  Card   /   Visa  / American 
					Express / Discover | 
                
                  | - Name on Credit Card: | 
                
                  | - Credit Card Number: | 
                
                  | - 
                  Billing Zip Code: | 
                
                  | - V-Code on back of card, 
					3 digit number: | 
                
                  | - Credit Card 
                  Expires: | 
                
                  | -Signature of card holder:
 
 | 
                
                  | When Completed, 
                  Fax To 586.775.0567 |