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Fax Order Form
CCR Trading
32800 Giboney Rd.
Hempstead, TX 77445
Fax Number
PLEASE PRINT ALL INFORMATION
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ITEM # |
PRODUCT DESCRIPTION |
QUANTITY |
UNIT PRICE |
TOTAL PRICE |
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SUBTOTAL |
$ |
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SHIPPING & HANDLING |
$ 5.00 |
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TOTAL |
$ |
| NAME |
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SHIP-TO ADDRESS:
STREET AND HOUSE OR APARTMENT # |
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| CITY, STATE, and ZIP CODE |
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| TELEPHONE # |
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CREDIT CARD TYPE
(We accept Mastercard, Visa, and American Express) |
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| CREDIT CARD # |
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| CREDIT CARD EXPIRATION DATE |
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SIGNATURE
(If paying by credit card)
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