Effective Visual Solutions, Custom Tags and Signs for Your Safety and Smile...
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| STEP 1: BILLING INFORMATION | Payment Type (check one): |
| First Name: | VISA MasterCard Check/Money Order |
| Last Name: | < For Credit Card Order Only > |
| Email: | Credit Card Number: |
| Telephone Number: | Credit Card Expiration Date (Month/Year): |
| Fax Number: | Total Charge Amount (US$): |
| Billing Address: | Signature: X |
| City: | Zip Code (Postal Code): |
| STEP 2: SHIPPING INFORMATION (If different from Billing Information.) | |
| Recipient's Name: | (Please use a separate form for each recipient.) |
| Recipient's Address: | Recipient's Zip Code (Postal Code): |
| STEP 3: PRODUCT INFORMATION | |
| Item Number: | Price per Unit: |
| Item Name: | Quantity (Same Engraving Information): |
| Wrist Size (for Bracelet Order) | Subtotal (Quantity x Unit Price) |
| Option(s) you selected: | Add 7.75% Sales Tax (CA Residents only): |
| STEP 4: ENGRAVING INFORMATION | |
| Front (selected items only): | Back: |
| Line 1: | Line 1: |
| Line 2: | Line 2: |
| Line 3: | Line 3: |
| Line 4: | Line 4: |
| Line 5: | Line 5: |
| Line 6: | Line 6: |
| Line 7: | Line 7: |
| Line 8: | Line 8: |
| Line 9: | Line 9: |
| Line 10: | Line 10: |
| Thank you for your order! | |
| Please make checks payable to: Moonlight Pacific | |
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Mailing Address: P.O. Box 230208, Encinitas, California 92023-0208 TEL: (760) 213-2954 FAX: (760) 230-1825 © 1999-2004 Moonlight Pacific - Tags, Signs and Effective Visual Solutions - www.tagsquare.com |
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