Handmade Electronics
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Fax or mail in order form
All fields must be filled out. Updated 9/19/07. Print this form off your screen by right clicking mouse.
E-mail address:
Name as on card
:
Address1 (include Street,Road,etc)
:
Address2:
City:
State/Provence:
Postal Code:
Country:
Telephone (
must
include):
Fax (optional):
1) For sales, use of this form indicates Sales Terms and Conditions are understood.
No use of other's cards without their express written permission. The card owner must place the order, or send a confirming email or fax.
Line No.
Quantity
Part Number
Description (brief)
Price Ea.
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Signature:_______________________________________________________________
Card Info
Card Number
Expiration Date
3 digit CVV security code* (REQUIRED)
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*- 3 digit code is in back of card in the signature area. (follows the last 4 digits of your account number). Amex Express CVV is 4 digits on front of card.