ORDER FORM
Right click on your mouse and PRINT the form for any faxed or mailed orders. For email, you can scan form once it is filled out and email your order to us.
ORDER FORM for EMAIL - PHONE - FAX:
Name: ____________________________________________________________
Address: __________________________________________________________
City: ____________________________ Postal Code:_______________________
Delivery Address:____________________________________________________
City:_____________________________ Postal Code: ______________________
Phone Number: ______________________________________________________
Email: ____________________________________________________________
Shipping Instructions: ________________________________________________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Taxes _______________
Shipping ________________
TOTAL COST _______________
METHOD OF PAYMENT:
___ Credit Card ____ Money Order
Charge the credit card number supplied below.
C/C : ______________________________________________________ exp. date : ________
Name oN Credit Card _______________________
Please sign : __________________________________________
Authorized purchase amount $_________
Name: ____________________________________________________________
Address: __________________________________________________________
City: ____________________________ Postal Code:_______________________
Delivery Address:____________________________________________________
City:_____________________________ Postal Code: ______________________
Phone Number: ______________________________________________________
Email: ____________________________________________________________
Shipping Instructions: ________________________________________________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Product:_______________________ Item No.:_______________
Color:___________________________________ Quantity: _____ Price _________
Product:_________________________ Item No.:_______________
Color:__________________________________ Quantity: _____ Price _________
Taxes _______________
Shipping ________________
TOTAL COST _______________
METHOD OF PAYMENT:
___ Credit Card ____ Money Order
Charge the credit card number supplied below.
C/C : ______________________________________________________ exp. date : ________
Name oN Credit Card _______________________
Please sign : __________________________________________
Authorized purchase amount $_________