White Oak Orchids Fax Order Form

Billing Information

( The same as on your Credit card statement)

Name: _________________________     Street:__________________________

City: _____________________   State:_______ Zip Code:__________        

State:: ______ Zip Code:_________  Signature:______________________

Email :__________________________

Payment Types: Discover, Master Card, Visa

Card Information: Card number:_____________________________

Exp. Date Month:________ Year:_______ Security Code _____________

(The security code or CV are the last 3 digets on the signature line of the card)

The Order must be signed to complete the order. Date: _________________

Items Ordered:                Quanity                   Unit price                       Total

1.________________       ________                  _________                   ______

2. ________________       __________              _________                  ______

3. ________________       __________              _________                  ______

Order Sub Total __________

Our Mailing Address: 1456 Oxford Street            ( CA) Sales Tax 9.50% _______

Redwood City, CA                                        Packing and Shipping Charges- Call or Email

94061-2815                                                     Total of Order __________

Contact Telephone numbers:    Day : ___________________

Alternate:____________________    Fax:__________________

Shipping: To be added at time of shipment ( packing and Freight is Approximately 18 % to 24 % of the order total.)

Please choose one: Fed Ex 2nd Day, Express, Overnight standard or USPS priority mail or Express mail.

Please use additional paper for additional items or information. Thank You for your order!

 

This e-mail address is being protected from spambots. You need JavaScript enabled to view it