LCDSearch.com. FAX ORDER FORM
Address: 7380 N Indian Lake, Scotts, Michigan 49088
Print out this form and fax it to (269) 382.4747

CREDIT CARD ORDER FORM

I HEREBY AUTHORIZE World Networking Group / World of CD-ROM / LCDSearch.com  TO CHARGE MY CREDIT CARD FOR MY PURCHASE.

CUSTOMER/COMPANY NAME: __________________________________________
(AS APPEARS ON CREDIT CARD)
PURCHASE ORDER NUMBER:  __________________________________________
REQUESTED PART NUMBER:
  PART NUMBER   QTY
   
   
   
   
PART PRICE:                      USD $ _______________
(AS QUOTED IN EMAIL)
SHIPPING CHARGE:         USD $ _______________
(REFER TO OUR WEB SITE)
TOTAL AMOUNT:              USD $ _______________
TYPE OF CARD:          VISA MASTER EscrowTrans
BANK NAME OF ISSUING CREDIT CARD: _________________________________
CARD NUMBER: _______________________________________________________

CARD CODE:___________________________________________________________
(FOR VISA/MASTER CARDS-LAST THREE DIGITS ON BACK OF THE CARD NEAR OR UNDER SIGNATURE LINE.FOR AMERCAN EXPRESS- FOUR DIGITS ON TOP OF CARD NUMBER.)

EXPIRATION DATE: MONTH_______/YEAR________
  SHIPPING ADDRESS BILLING ADDRESS (IF DIFFERENT)
NAME    
ADDRESS    
CITY, STATE ZIP CODE    
COUNTRY    
PHONE NUMBER    
EMAIL    
HERE BY I AUTHORIZE WORLD NETWORKING GROUP TO CHARGE MY CREDIT CARD FOR MY PURCHASES.   I HAVE READ AND AGREE TO ALL TERMS AND CONDITIONS HEREIN.
CARD HOLDER'S SIGNATURE:________________________________________________
DATE:_____________________________

 LCDSearch.com is a subsidiary of the World Networking Group, known here in as World Networking Group, 7380 N Indian Lake, Scotts, MI 49088 (269) 649.4949 Fax (269) 382.4747 Email Address officeJT@WorldNetworkingGroup.com / Sales@LCDSearch.com

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