Order Form
Order form
tel.562 433-9000
fax 562 433-9055
3323 east Broadway Long beach ca 90803
Date.............................................................................................................................................................................
Company name............................................................................................................................................................
Last name........................ First name.............................................................................................................................
Address1.......................................................................................................................................................................
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Address2......................................................................................................................................................................
City........................................................................................... state.............................zipcode..................................
Country.......................................................................................................................................................................
Order number........................................................................................... PCs.............................................................
Order number........................................................................................... PCs.............................................................
Order number........................................................................................... PCs.............................................................
Order number........................................................................................... PCs.............................................................
Order number........................................................................................... PCs.............................................................
Order number........................................................................................... PCs.............................................................
Name on card..............................................................................................................................................................
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Visa #.............................................expiration date.................................................. ....................................................
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Month..................................................Day........................Year...............................................................................
Master card #..............................................................................expiration date.......................................................
Month...................................................Day..........................Year.............................................................................
Discover #...........................................expiration date................................................................................................
Month..................................................Day..........................Year..............................................................................
Additional information
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Please allow 2 to 4 weeks for shipment .
Shipping and handling extra.