| PAYMENT
INFORMATION - Checks payable to CoolBalls |
| Name: |
| Address: |
| City: |
State: |
Zip: |
| Phone: |
E-Mail: |
| Credit Card Number: |
Expiration Date: |
_____ / _____ / _____ / _____ |
_____ / _____ |
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| PRODUCT
INFORMATION |
| Description |
Qty.
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Price
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Total
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SHIPPING INFORMATION
USPS - GROUND = $3.25
USPS - PRIORITY MAIL = $6.25
No matter how many balls you order, shipping is always one low rate! |
| SubTotal |
|
| Tax
7% - GA. Only |
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| Shipping |
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| Total |
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| SHIPPING
INFORMATION - (If Different from Payment info) |
| Name: |
| Address: |
| City: |
State: |
Zip Code: |
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| SIGNATURE |
By signing this form you agree that (1) you are the credit card holder listed (2) that you are requesting the products listed above and (3) that you are authorizing this card to be charged by Cool Balls for the total of your purchase.
Signature: _______________________________
Date: __________________
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Thank you for your business.
