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FAX Order Form
Print this form, then fill
it out and fax it to: 1-818-484-2124
| Date:
_______ / _____ / _____ |
Ship To : Company
Name : __________________________________________________________
Name : ___________________________________
Address : ____________________________________________
City : _____________________________ State : _____________
Zip : _______________
Day Tel : __________________________ Email Address
: _____________________________________
[ ] Residence [ ]
Business (Please check one)
Bill To :
[ ] same as
shipping address
Name : ___________________________________
Address : ____________________________________________
City : _____________________________ State : _____________
Zip : _______________
Order Information
| |
Item# |
Package Price |
Quantity |
Amount |
| 1 |
________________________________________ |
________ |
________ |
_______ |
| 2 |
________________________________________ |
________ |
________ |
_______ |
| 3 |
________________________________________ |
________ |
________ |
_______ |
| 4 |
________________________________________ |
________ |
________ |
_______ |
| 5 |
________________________________________ |
________ |
________ |
_______ |
| 6 |
________________________________________ |
________ |
________ |
_______ |
| 7 |
________________________________________ |
________ |
________ |
_______ |
| 8 |
________________________________________ |
________ |
________ |
_______ |
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Total :
|
______________ |
Shipping Method ( DOMESTIC )
Select
one : USPS Priority/ USPS Express / Next day
Shipping Method ( International )
USPS Global Express Mail (EMS) / USPS Airmail Parcel Post
Credit Card Information
Card Type : Visa / Master /
American Express / Discover
Credit Card # _______________________________________
Expired Date : ________/____________
Signature ____________________________________________
Note: You may be asked copies of
your credit card and photo ID if your shipping and billing addresses are
different. You will receive a confirmation email in a few hours. Please
make sure to check the email for your order. |
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For faster service please email us
info@watchpartssupply.com
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