hkDVDstore.com - Mail/Fax Order Form

hkDVDstore.com - Mail/Fax Order Form hkDVDstore.com Mail/Fax Order Form Please Make Sure All Fields Are Filled In. Print and Fax All Orders To:

NAME
STREET ADDRESS (INCLUDE APT/SUITE)
CITY, STATE, ZIP CODE
TELEPHONE
EMAIL ADDRESS

TITLE PRODUCT ID PRICE QUANTITY

- Use Another Sheet If Ordering More Than 10 Titles.

[ ] INSURE PACKAGE ($+1.25) | [ ] SIGNATURE DELIVERY ON PACKAGE (+$1.50)
* APPROPRIATE S&H FEE RANGING FROM $2.50 TO $6 (DEPENDING ON THE NUMBER OF TITLES ORDERED) WILL BE ADDED TO YOUR ORDER. PLEASE REVIEW THE S&H RATES ON OUR WEBSITE FOR MORE INFO.

*** CREDIT CARD AUTHORIZATION FOR ORDER CHARGE

CREDIT CARD NUMBER
EXPIRATION DATE
CVV2 (LAST 3 OR 4 DIGIT AFTER ACTUAL CARD NUMBER)
SIGNATURE (AUTHORIZING ORDER CHARGE)
PRINT NAME / DATE

ALTERNATE SHIPTO/ADDRESS

NAME
STREET ADDRESS (INCLUDE APT/SUITE)
CITY, STATE, ZIP CODE