Copyright 2010

SECURE ORDER FORM

 

IMPORTANT ! AFTER YOU SUBMIT THIS ORDER A NEW SCREEN

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

 

Special Note To FireFox & Apple Computer Users.

Please do not press the ENTER key during this session. Use the tab key or the mouse to advance to the next field.

CONTACT INFORMATION
E-Mail
Phone Number
First Name
Last Name
Company Name
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

the vendor 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

vendor 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 3 OR 4 Digit Security Code 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 ?