ORDER FORM

 Fax This Order Form To:

 

(678) 889-4433

 

Date:

 

Required Shipping Date:

 

    New Account

  Existing Account

 

Bill to: (Credit Card Billing Address)

 

Ship To: (If Different From Bill To)

Attention

 

Attention

Company Name

 

Company Name

Address

 

Address

 

 

 

City                                                 State             Zip

 

City                                                 State             Zip

Phone (         )         -

Fax (         )          -

 

Phone (         )         -

Fax (         )          -

 

Code No.

Description

Unit

Unit Price

QTY

Amount (US$)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Freight (Estimated)

 

Sub Total

 

Domestic Shipping (Est.):  12% of Total Sales

 

(Minimum US$100)

International Shipping:  Please Contact Us

 

Estimated Shipping

 

 

 

Total Amount

 

    Payment

  By Credit Card

    By Check

  Visa

  MasterCard

  American Express

Make Check Payable & Mail To:

Card Number

 

Star International Import & Export Inc.

Expiration Date

 

Security Code

 

5256 Bellewood Ct., #100

Card Holder Name (Print)

 

Buford, GA 30518

Card Holder Signature

 

The United State Of America

 

                                                        Any questions, please contact us toll free at 1 (877) 738-0701.