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Following the steps below to send us your order and payment information via fax: 1. Print this page first (you'll need these instructions
and the form at the bottom). Items with a bullet ( ● ) next to them are required. Ship-to Address ___ Check here if your order is a gift. Invoices sent to the
recipient ● First Name:_______________________________________________ ● Last Name:_______________________________________________ ● Address Line 1:____________________________________________ Address Line 2:____________________________________________ ● City:_____________________________________________________ ● State/Province:____________________________________________ ● Zip/Postal Code:___________________________________________ ● Country/Region:___________________________________________ Email:___________________________________________________ ● Phone:___________________________________________________
Payment Type and Credit Card Information ● Check which credit card you will be using: ___ Visa ___ MasterCard ___ American Express ___ Discover ● Credit Card Number:_______________________________________ ● Expiration Date:__________________________________________ ● Name As It Appears on the Card:____________________________
Billing Address ___ Check here if it is the same as the Ship-to Address above ● First Name:_______________________________________________ ● Last Name:_______________________________________________ ● Address Line 1:____________________________________________ Address Line 2:____________________________________________ ● City:_____________________________________________________ ● State/Province:____________________________________________ ● Zip/Postal Code:___________________________________________ ● Country/Region:___________________________________________ Email:___________________________________________________ ● Phone:___________________________________________________
Order Total ●
Subtotal:________________________________________________ ●
Shipping:________________________________________________ ●
Tax:____________________________________________________ ●
Total:___________________________________________________ |
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Copyright © 2008 Two Fish Concepts, LLC All Rights Reserved |