Fax Order Form For Master Card / Visa / Discover
Item # 1 _______________________________________________price ____________
Item # 2 _______________________________________________price_____________
Item # 3 _______________________________________________price_____________
Item # 4 _______________________________________________price_____________
Item # 5 _______________________________________________price_____________
Shipping_______________________________________________price_____________
TOTAL to charge to card__________________________________________________
Billing name on card ___________________________________________
Billing street address on card ___________________________________________
Billing city, state , zip on card ___________________________________________
credit card # ___________________________________________
credit card ccv # (last three numbers on back on signature line)______________
expiration date of card # ___________________________________________
telephone # ___________________________________________
I authorize this transaction (signature)________________________________________
Email address _____________________________________________________
After you print this form out fill in apropriate information and Fax to: 1-206-339-4756
You may also call us at 503-474-3083 9 AM - 7 PM Pacific Standard Time Please
I further agree that a 10% restocking fee will be assessed for returned items and a $25.00
fee is authorized in the event cancellation is requested on order after faxing.