First and Last
Name |
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Evening Phone
Number: |
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Cell Phone Number: |
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Billing Address
(according to your Credit Card Statement) |
Street Address: |
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Apartment Number: |
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City: |
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State: |
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Zip Code: |
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Foreign Country: |
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Country Code:
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State Code: |
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Shipping Address is the same as billing address - Check Box:
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Shipping
Address (If different than Billing Address) |
Street Address: |
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Apartment Number: |
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City: |
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State: |
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Zip Code: |
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Foreign Country: |
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Country Code:
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Charge Card Information
This information is only used for this order. |
Name on YOUR Card: |
|
Type of Card: |
VISA
MC AMERICAN EXPRESS
DISCOVER |
Charge Card
Number: |
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Charge Card
Expiration date: |
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Three digit Code
on the back of your card: |
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Your Signature:
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Today's Date: |
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Any Notes: |
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Thank you for your
order!
We generally require 2-4 days for handling. Then we send your items
via:
US Priority Mail (3-5 days) insured. You will have to sign for the
package.
If you are not home the Post Office will hold it for you to pick up.
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