TO
SAVE 2% on your order total close this window, and Choose to Pay via Wire
Transfer
Please Use This Form for Payment via credit card. This method requires faxing
or emailing additional documentation.
1. Copy of credit card bill.
2. Copy of the front and back of the credit card.
3. Copy of utility bill.
Please note payment via this option is subject to approval by our processing
team.
This option may be restricted to certain countries.
The shipping and billing address must be the same.
This form is for international orders and for those that do not wish to use
our online checkout. Please fill out all fields print it , and fax it to us
at ++1718-360-5983. This form can be filled in by typing or can be printed
and then filled in by hand.
Item
Description
Company: Collection:
Model # : Size:
Quantity:
Price:
Shipping
to NY is subject to NYS and County taxes.
Shipping
Info
Name
Company Name:
Address
City: State:
Postal
Code: Country:
Telephone # where we can reach you
Best time to call:
E-mail Address:
Billing Info All information must be identical to that on your credit
card.
Credit Card Type : (Visa,
MasterCard, American Express, Discover)
Credit Card Number: Expiration
Date:
CID No. (Visa/MasterCard/Discover
- the last 3 digits printed on the reverse side of your card - usually on the
signature panel. American Express - the 4 digit number printed on the face of
the card directly above the last numbers of the credit card)
Name and address must be as appears on your bill.
Name :
Address:
City: State:
Postal
Code:
Country:
Shipping Options:
Fed Ex International $80.00*
Fed Ex Shipping to Canada, PR or US Virgin Islands $40.00
Card Holder Signature
Date /
/
*If
you are paying with credit card please attach a copy of the front and back of
the credit card being used & a recent credit card bill from the card you
are using. (We ask for this information to help protect against fraud and to
be able to verify the credit card information provided.)
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