|
In order to fax or mail your
order in please print out this form and fax to:
AAAPRICE.COM INC,
333
86th. St.
Suite: 1D
Brooklyn NY 11209
PHONE:718-836-6809 FAX :718-836-6754
| Bill To: |
| Name:______________________________ |
| Address:____________________________
___________________________________
|
| City:_____________________State:______ |
| Zip___________Phone:_____________________
Email:____________________________
|
|
| Ship to: |
| Name:________________________________ |
| Address:______________________________
_____________________________________
|
| City:____________________State:_________ |
| Zip:__________Phone:___________________ |
| Email:___________________________
|
|
| QTY |
ITEM |
|
DESCRIPTION OF ITEM |
PRICE |
TOTAL |
| . |
. |
|
|
$ |
$ |
|
. |
|
|
$ |
$ |
| . |
. |
|
|
$ |
$ |
| Payment
Method:
[__] VISA
[__] MASTERCARD
[__] Discovery
[__] Money Order,Check Enclosed |
NY
State Residents Please add
Tax (8.375%) |
$ |
| Shipping
(Please see info. for the shipping charges) |
$ |
| Total
|
$ |
|
I hereby authorize
you to charge my credit card as payment for the above items
|
| Credit Card
Number:__________________________________________ |
| Exp
Date:___________________Amount:$______________ |
| City:
___________________State: _______ |
Signature:_____________________________ Date:__________ |
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