email this completed form to: Tdst Inc.,
at
info@ourcellph.com
( Print this form: click Edit, click
Select all, click File, click Print)
SHIPPING INFO
|
BILLING INFO (fill in only if different) |
| Name |
____________________ |
Name |
____________________ |
| Address |
____________________ |
Address |
____________________ |
| Address |
____________________ |
Address |
____________________ |
| City |
____________________ |
City |
____________________ |
| State |
____________________ |
State |
____________________ |
| Zip |
____________________ |
Zip |
____________________ |
| Phone |
____________________ |
Phone |
____________________ |
| Email |
____________________ |
Email |
____________________ |
| CREDIT CARD INFO (if not paying by check or money order) |
| |
| Card # |
____________________ |
Exp. |
____________________ |
| Name on Card |
____________________ |
Type |
Visa Mastercard Amex Discovercard
(circle one) |
| CSC Code |
____________________ |
|
| SHIPPING RATES |
| Method/Location |
Orders up to $49.99 |
Orders $50.00 & up |
| UPS Ground (48 contingous US States) |
$8.00 |
$10.00 |
| US Priority Mail (APO, FPO, PO Boxes only) |
$10.00 |
$12.00 |
| Alaska & Hawaii (UPS 2 Day Air) |
$32.00 |
$32.00 |
| Canada (UPS Express) |
$36.00 |
$41.00 |
| UPS 2 and 1 Day Express (48 contingous US States) |
|
|
| Alaska & Hawaii (UPS 1 Day Air) |
$66.00 |
$66.00 |
| |
|
|
| PURCHASE INFO |
| Product Sku# |
Description Size/Color (if applicable) |
Qty |
Price Ea. |
Total |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| ______ |
_______________________________ |
____ |
$_______ |
$______ |
| |
|
Subtotal |
$______ |
| Shipping Method |
_______________________________ |
Shipping |
$______ |
| |
|
GRAND TOTAL |
$______ |
If there is not enough room on this form attach your own paper or use two forms.
Mail this completed form to: info@ourcellph.com