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ORDER
INFORMATION FORM Print and FAX
Fax # 1-860-669-6982
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| Boat
Name:___________________________________________ |
| Today
Date:___________________________________________ |
| Delivery
Date:___________________________________________ |
| Customers Name:___________________________________________ |
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Merchandise
(Any Questions Please call) |
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Product
Number listed on the price list |
Product
Description |
Dimensions (if needed) |
Quantity |
Total |
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______ |
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_______ |
_____________________________ |
______________ |
______ |
______ |
NAME |
______________________________ |
STREET |
______________________________ |
CITY |
____________________ |
STATE |
_____________ |
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ZIP Code |
_____________ |
DAYTIME PHONE |
____________________ |
NAME |
______________________________ |
STREET |
______________________________ |
CITY |
____________________ |
STATE |
_____________ |
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ZIP Code |
_____________ |
DAYTIME PHONE |
____________________ |
METHOD OF PAYMENT
(Please, no cash)
|
______MONEY
ORDER |
_______VISA |
_______MASTERCARD |
|
______AMERICAN EXPRESS |
______DISCOVERY CARD |
FOR YOUR PROTECTION, ALL CREDIT CARD ORDERS ARE VERIFIED
!
ISSUING BANK |
______________________________ |
| YOUR SIGNATURE |
______________________________ |
| CARD NUMBER |
______________________________ |
| EXPIRATION DATE |
______________________________ |
| S.E.C. Code on
the back of your card 3 numbers or letters |
______________ |
FOR YOUR PROTECTION, ALL CREDIT CARD ORDERS ARE VERIFIED
!
|
YOUR
SIGNATURE
_________________________________________ |
Voice 1-800-235-2628
Fax 1-860-669-6982