Fax Order Form send to (1) 610-546-1964
Print
this page and send this form to the above number
Fax Order Form send to (1) 610-546-1964
Print
this page and send this form to the above number
| Quantity |
Product |
Price $ |
Subtotal |
|
Shipping
and handling |
$
12.95 |
||
|
Countries outside USA/Canada/Europe/Australia/NZ: Please add US$10.00 postal insurance to cover against lost/damaged goods. We cannot replace or refund your order unless this insurance is added to your total payment. (Only applicable OUTSIDE USA/Canada/Europe/Australia/NZ) |
|||
TOTAL US$ |
|||
|
All fields must be filled in for order to be processed (BLOCK, capital letters please) Name ________________________________________________________________ Address _______________________________________________________________ City ________________________State ____________ Postal/Zip ________________ Telephone _____________________Email ____________________________ Card Number:____________________________________________________ Card Verification Number ___________(last 3 numbers on the back of the card) Card type (Visa/Master) ___________Expiry Date_________US$___________ Card holder billing address if different from above, otherwise leave blank: ______________________________________________________________________ ______________________________________________________________________ Signature ___________________________________
|
| Fax this form to 610-546-1964 - Your payment receipt and order confirmation will be sent to your email address. Allow up to 5-10 days for delivery. Thank you for your custom! |