Credit Card Order Form                                                                                                                                                                                            BACK HOME

 

                                                          CREDIT CARD ORDER FORM

CARDHOLDER NAME     

.

COMPANY NAME            

.

MAILING ADDRESS        

.

PHONE NUMBER             

.

CITY, STATE, ZIP CODE  

.

CREDIT CARD TYPE        

.

CREDIT CARD NUMBER

.

EXPIRATION DATE          

.

 

DESCRIPTION

SKU#

Qty.

PRICE

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Orders will be shipped within 24 hours after card has been processed. 

Please print this form, fill out and fax to
 248-757-2794

subtotal

.

 tax (6%) MI

.

S&H

 

Total

 

Please send the Order Form with the Credit Card Payment Authorization Form (download) *

* Required

 

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