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BatteriesFAST - Fax Order Form
Please fill out form LEGIBLY and mail to address below:

1. Personal Information

Please enter your Name and Address as listed on your Credit Card Statement:
FirstMILast
Company
Address
CityStateZip
Country

Please include contact info. (Day Phone Required for Carrier)
Day
Ext.Hours:How did you find us?
NightExt.Hours:("Yahoo", "Excite",etc.)
E-Mail

2. Credit Card Information
Credit Card # Exp. Date:
If you are using a Check Card / Debit Card please include
the bank it is drawn on and their telephone number to
expedite your order . You will usually find this info on the
back of the Check Card / Debit Card.
Bank Name Phone #

3. Product(s)
Your Computer is a:
Qty Order# Make Model Each Total
1.
2.
3.
4.
5.

4. Totals & Shipping
Merchandise Total $
Processing Charge $
Subtotal $
Sales Tax (8.25% CA Only)
2nd Day Delivery $
Overnight Delivery $
Total Charges $
Thank You for Your Order!
Comments/Ship-To Address (if different than above - delays may result):


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