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SECURE ORDER FORM         

IMPORTANT ! AFTER YOU SUBMIT THIS ORDER A NEW SCREEN

WILL PRESENT YOU WITH A VISUAL CONFIRMATION ALONG WITH YOUR ORDER NUMBER.

   

 
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CONTACT INFORMATION
Company Name
Full Name
E-Mail  
Phone Number
SHIPPING DETAIL
Is Delivery To A Residential Address ?
Purchase Order / Reference #
Attention
Street
Suite / Unit
City
State / Province
NON USA/CANADA
Zip Code / Postal Code
Country
Ship Via
Carrier Account # ( Required for next day delivery.)
Alternative Shipping Method

TERMS

Client agrees that all prepaid freight charges will be added to the invoice and that

Complex Plastics will not be held responsible for delays, lost items, damages or

non performance by carrier. Client accepts any and all additional freight

charges for this order to be added to the credit card should

Complex Plastics receive additional billing from carrier for either

corrected weight, dimension changes or any other charges that may be levied

in addition to the original freight charges.

Orders for custom made items are not cancelable nor returnable

for any reason whatsoever. All items ordered via email without a

written purchase order are non returnable.

TYPE USING ALL UPPER CASE CHARACTERS INTO THE BOX BELOW

I AGREE

 
CREDIT CARD
Credit Card Type
Card Holder's Name
Bill To Street
Bill To City
Bill To State / Province
Bill To Zip / Post Code
Country
Credit Card # ( No Spaces )  
Card Expiry Date ( MM / YY)  
The Security Code On The Back Of Card
REFERED BY
How Did You Find Us ?
Promotion Code
ITEM 1 DETAIL
Quantity
Item Description  
Product ID ( If Known )
Unit Price
ITEM 2 DETAIL
Quantity
Item Description
Product ID ( If Known )
Unit Price
ITEM 3 DETAIL
Quantity
Item Description
Product ID ( If Known )
Unit Price
ITEM 4 DETAIL
Quantity
Item Description
Product ID ( If Known )
Unit Price
ITEM 5 DETAIL
Quantity
Item Description
Product ID ( If Known )
Unit Price
Additional Items / Comments ?