Order Form to Fax
Date _________________________
Payment Method: If using a purchase order from the school, you need to fax , send or e-mail it with your order.
Credit card # _____________________________________________, Expiration date___________.
Last 3 #'s on back of credit card______________
| Ship To: |
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| Attn: |
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| Address |
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| City, State, Zip Code |
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| Address where credit card statement is sent |
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| City, State, Zip where credit card statement is sent |
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| Fax # |
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| Day Phone |
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| Best time to call |
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| Home Number |
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| e-mail address |
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| Special Instructions |
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| Quantity Ordered |
Description |
Unit Price |
$ Amount |
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Signature:_______________________________________________________________________ Date _________________________
Fax: 888 530-7654
Make sure to add Shipping.
Shipping
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