[
Internetwines.com
] [
Faxable Order Forms
]
[
Single Recipient
] [
Multiple Recipents
] [
Corporate Orders
]
Directions:
1. PRINT OUT THIS PAGE & FILL OUT (Yellow Sections are Optional)
2. FAX ORDER TO:
618-394-9383
3. Use additional paper if needed.
CONTACT INFO
BILL TO:
Name
Name
eMail
Address
Address
Phone
City, ST. Zip
Fax
Phone
Payment type
Credit Card Number
Exp
.
MC / VISA / DISCOVER
Ship Method
Ship Date
Overnight / 2nd Day / 3 Day / Ground / Saturday
Qty.
Code
Item Description
Unit Price
Total
Recipient Information
Name
Address
City, State. Zip
Address
Gift Message
:
Name
Address
City, State. Zip
Address
Gift Message
:
