BAYTECK COMPUTER SHOP
Please print
this form out and fax it to us. To ensure that our customers' credit card
information is protected when making a computer purchase, we prefer that orders
are faxed to us. Please send us e-mail if you have any
questions.
Personal InformationName: __________________________________________________________________
Company: __________________________________________________________________
Address: __________________________________________________________________
__________________________________________________________________
City: ___________________________ State: _____ Zip Code: _________
Daytime Phone: _____________________ Work Phone: _____________________
E-mail address: ____________________________________
Please send me the following products:DESCRIPTION PRICE QTY SUBTOTAL
_______________________________________ _____ ___ ________
_______________________________________ _____ ___ ________
_______________________________________ _____ ___ ________
Shipping & Handling +________
TOTAL ________
Credit Card InformationCredit card (VISA, MASTER CARD) Card Number: ___________________________________ Exp. Date: __________ Name on card: ___________________________________ Signature: ______________________________________ Date: ___________ Billing address:___________________________________________________
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