CRYSTAL FLORIDA
PRINTABLE ORDER FORM
*You can either submit your order through this page or print and fax it to;
(239)732-6332
*We accept checks, major credit cards, money orders and
PayPal
QTY
Item#
Description
Unit Price
Total
"Gift Wrap" requested? (add $3.00)
"Gift Card" requested? (add $1.00)
Sub Total:
*Only "ACTUAL" shipping fee will be added to your bill.
Shipping Information:
Name :
Address :
City :
State :
Zip :
Phone :
E-mail :
Billing Information:
(if different )
Name :
Address :
City :
State :
Zip :
Phone :
E-mail :
PO Number if applicable: :
If you wish to pay by credit card, please fill out and fax completed form to
(239)732-6332
.
If we already have your information, please simply state "Use card on File!".
CARD TYPE :
Visa
Master
AmericanExpress
NUMBER :
EXP. DATE :
NAME ON CARD :
Additional Instructions
or "Message on the gift card" :