Learn More Before You Invest...

Please complete the secure order form below. Or use the Print Option on your browser and mail to:
ClaimTek Systems, 3943 Irvine Blvd,. #39, Irvine, CA 92602-2400. Or fax your order to (800) 503-9461.
For any questions, please call customer service: 800-224-7450.

Secure Order Form:

*	First Name:
*	Last Name:
*	Phone #:	Ext:
*	Street Address:
*	City:
*	State:	*Zip Code:
*	E-Mail Address:
*	Confirm E-Mail:
*	Card Type:
*	Card Number:
*	CVV Code: (3 or 4 Digits)	What is CVV Code
*	Expiration Date:	/

Please enter address where you receive your monthly credit card statement:

*	Name as it appears on Card:
	Address(Same as Above):
*	Street Address:
*	City:
*	State:	*Zip Code:
*	Yes, I would like to order the "Sampler Package" for $59.95 including shipping and handling. I understand that If I decide to purchase any product from ClaimTek then I can keep the "Sampler Package" and my $59.95 will be applied as CREDIT towards ANY ClaimTek product I purchase.

(800) 224-7450

Learn More Before You Invest...