Number:___________________________________________________
|
Expiration:_________________ |
| Name on
Card:______________________________________________ |
Signature:__________________________________ |
Card Billing Address:
(Shipping & Billing address MUST match)
_______________________________________________ _______________________________________________
|
|
Ship via: (You
pay shipping)
US Mail *,
FedEx,
UPS **,
Other:_____________________________________________
|
Name:______________________________________________________________________
|
|
Address:_____________________________________________________________________
|
|
City:________________________________________________________________________
|
State/Province:_________________ |
Country:__________________ |
Zip/Postal Code:____________ |
Telephone:__________________________________________________ |
|
|
Email:______________________________________________________
|
|
|
Item
Description:_____________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
|
| Price:______________ |
Michigan Residents Add 6% |
Total:____________________ |
| Shipping and
Insurance Charges as Applicable
|
|
|
|
|
|
|
| * Mainly what we use/ship (cheapest) |
** Must provide UPS Account |
For USPS shipping (your expense): Would you like Delivery
Confirmation? ____ Would you like Insurance? _____. |