Credit Card Payment Form

CHARGE !!!

CREDIT CARD ORDER FORM

Credit Card TERMS :ALL SALES FINAL / NO Refunds / No Exchanges

**CHILD UNDER THE AGE OF 13 MUST HAVE PARENTAL CONSENT TO SUBMIT ORDER FORM.

ORDER FORM

Dealer and Retail Price List Good Through 3 01 07

	MODEL>	DELUXE	ORIGINAL	6 PAC	12 PAC	24 PAC	36 PAC
1-35 Units	DEALER COST	$3.75	$3.25	$2.75	$3.25	$4.75	$7.25
	RETAIL PRICE	$6.75	$5.75	$4.75	$5.75	$9.50	$14.75

ENTER QUANTITY & UNIT PRICE

MODEL Quantity Unit Price Model Quantity Unit Price

DELUXE 12 PAC

ORIGINAL 24 PAC

6 PAC 36 PAC

ENTER UNIT Amount $ X 2.35

Payment Handling Fee (5.00%) of total UNIT PRICE due.

ENTER CONFIRMATION NUMBER INTO BLUE BOX & PAYMENT AMOUNT IN GREEN BOX

CREDIT CARD CONFIRMATION # AMOUNT DUE $

Enter Shipping INFO into Gray Area and Order Summary into Red & Blue Area

Name

Address

City / State / Zip

Buyer's Area Code/Phone Model Quantity

Special Instructions

- - - - - - OFFICE USE ONLY - - - - - -
Payment Received ___ / ___ Sign._______ Ship Date ___ / ___ Sign. _______

COPY & PASTE WHITE ORDER FORM TO BODY OF E-MAIL FORMAT

Click Here for Blank E-mail Format Kork~Off USA@ameritech.net

Do not attachment files to to e-mail format; attachments are never opened.

- - - - - THIS RED BOX IS NOT PART OF THE ORDER FORM - - - - -

DO NOT HIGHLIGHT TEXT IN THIS RED BOX

KLICKITLINK MENU

CLICK HERE TO PLACE ORDER BY CASH OR CHECK PAYMENT

Hit Counter

KLICKIT SNAIL MAIL IN ORDER FORM & CASH OR CHECK PAYMENT

KLICKITE-MAIL ORDER FORM AND SNAIL MAIL IN PAYMENT

- - - - - - OFFICE USE ONLY - - - - - - Payment Received ___ / ___ Sign._______ Ship Date ___ / ___ Sign. _______

- - - - - - OFFICE USE ONLY - - - - - -
Payment Received _ / _ Sign._____ Ship Date _ / _ Sign. _____