C4component.com - Order Form & Credit Card Agreement

ORDER FORM / Credit Card AGREEMENT

Today's Date: Repeat customer? Yes Do you have a Purchase Order# :

*Billing Info / Credit Card statement's address		*Ship to address (if different from billing info)
*Name:
Company:
*Address:

*City:
*State/Zip:
*Country:	<Credit Card purchase is limited to customers with US billing & shipping address only>
*Email:		*Daytime phone#:
* Required areas, must be all filled out correctly & legibly to process order.

Qty.	Item no.	Item description	Price	Total
			$	$
			$	$
			$	$
			$	$
<If order more than 4 different items, please list them on a separate sheet >Sub-total:				$
Order ships to California State must add 8.25% sales tax:				$
Shipping & handling:				$
(Sub-total + sales tax + s/h)Grand total:				$


Pay by: PayPal Money Order Cashier's Check Personal Check Company Check

Pay by Credit Card:	VISA	MasterCard	American Express
First Name on The Card: Last Name on The Card:
Card #: Expiration Date: CIN**#:
**(CIN#: This is a 3 or 4 digit number that's PRINTED on the front or back of your card, but is not part of the credit card number itself)

Card holder's signature:
Credit Card order will not be processed without signature

- a C4Component.com company -

Price and availability subject to change without notice.
For details on Payment Options, Terms & Warranty, go to:
www.c4component.com/order_info.htm & www.c4component.com/terms_warranty.htm
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