Order Form Page

GIFT BOX ORDER FORM *THIS FORM IS PRINTABLE ONLY. Please print, complete, and fax or mail to the number or address above*
*CUSTOMER INFORMATION*
*BILL TO* Name: ________________________ Address: _________________________ _________________________ Phone: _____ / _____ / ________	*SHIP TO* Name: ________________________ Address: _________________________ _________________________ Phone: _____ / _____ / ________
*PAYMENT INFORMATION*
CHECK ONE: Visa ____ MasterCard ____ Discover ____ Check ____
(For credit card orders) Card Holder: _____________________________ Account #: _______________________________ Expiration Date: ______/_______
*ITEMS*
Please indicate the quantity of each item below Gift Box A ________ Gift Box B ________ Gift Box C ________ Gift Box D ________
*SHIPPING*
Shipping Method: _____________________________ Desired Ship Date: _____/______/______