Fax to 936-449-5124

 

Order / Credit Card Release

Date:  10/9/2003

Billing Address:                                                                 

Shipping Address:

 

 

IN-HAND DATE:

 

 

 

 

 

Item

Quantity

Foam/Vinyl Color

Imprint Color

Price Each

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Setup Charge (add $35.00 for custom imprinted items)

 

Shipping estimate

 

TOTAL

 

I agree to pay with:  (circle one)                                       

                                                                                                                                                                                               

VISA          MASTERCARD          AMERICAN EXPRESS         

Text Box: Date: Card Number: Exp. Date: Name: Total Amount: $ App. # __________________ Authorized Signature/Name
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Thank you,

Credit/Accounts Receivable