ORDER FORM

Order Information:				Order Form:
Phone:  (000) 777-9999				ITEM #	CATEGORY/DESCRIPTION	PRICE		QTY.		TOTAL
Fax Form :  (000) 777-8888
Send Form Via Mail To: COMPANY NAME Street Address, Suite# City, State, Zip Code Country (if overseas)
								Subtotal
								Tax
								Total
Terms and Conditions:  List terms, conditions and policies here. Exerci tation ullamcorper suscipit lonis ut Sed diam nonummy euismod tincidunt ut laoreet dolore magna aliquam erat wisi enim adminim veniam. Duis autem vel eum iriure dolor hendrerit in vulputate velit molestie consequat, vel illum dolore feugiat nulla				Ship To:
				Name
				Company
				City		State
				Country		Zip
				Email
Shipping Information: List shipping information, conditions and other policies here. Exerci tation ullamcorper suscipit lonis ut Sed diam nonummy euismod tincidunt ut laoreet dolore magna aliquam erat wisi enim adminim veniam. Duis autem vel eum iriure dolor hendrerit in vulputate velit molestie consequat, vel illum dolore feugiat nulla				Billing Address:
					Check here if Shipping/Billing address are the same
				Name
				Company
				City		State
				Country		Zip
				Email
				Billing Information:
				Credit Card #
				Cardholder Name
				Card Number
				Expiration Date

If you have any questions, please contact our Webmaster or phone (x5555). Copyright 1997 Company Name, Inc. All rights reserved.