|
HOW TO USE THIS ORDER FORM
SMART RETAIL SOLUTIONS, INC. 888-887-6278
- PRINT OUT THIS PAGE & FILL OUT (Light Gray Sections are
Optional)
- FAX ORDER TO: 1-540-344-8640 (direct personal fax)
| CONTACT INFORMATION
(all required) |
| Name |
|
Phone |
|
| Email |
@
|
Fax |
|
| SHIP TO: |
|
|
BILL TO: |
(where
credit card bill is sent) |
| Company Name |
|
|
Name
on card |
|
| Address |
|
|
Address |
|
| Address |
|
|
Address |
|
| City, State, Zip |
|
|
City, State, Zip |
|
| Phone |
|
|
Phone |
|
| Payment type
(circle one) |
Credit Card
Number |
Exp.
date mm/yy |
| MC / VISA / DISCOVER
/ AMEX |
|
/ |
| SHIP VIA
(circle one) |
SHIPPING OPTIONS
(fees will be added to order) |
Bill
Sender acct. # (optional) |
| USPS
Priority |
(No options: Priority Tracking
# will be issued) |
////////////////////////////////////// |
| FEDEX |
Overnight /
2nd Day / 3 Day / Ground / Saturday |
|
| Qty. |
Code |
Item
Description |
Unit
Price |
Total |
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| Special
Instructions |
Subtotal |
|
| Tax (VA) |
|
| Freight (TBD) |
////////////////// |
| Total |
/////////////////// |
SMART RETAIL SOLUTIONS, INC. (888) 88-SMART (888-887-6278)
FAX to 540-344-8640
Post Office Box 4123
Roanoke, VA 24015 www.smartretail.com
|