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LCDSearch.com.
FAX ORDER FORM
Address: 7380 N
Indian Lake, Scotts, Michigan 49088
Print out this form and fax it to (269) 382.4747
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CREDIT
CARD ORDER FORM
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I
HEREBY AUTHORIZE World Networking Group / World of
CD-ROM / LCDSearch.com TO CHARGE MY CREDIT CARD
FOR MY PURCHASE.
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CUSTOMER/COMPANY
NAME: __________________________________________
(AS APPEARS ON CREDIT CARD) |
PURCHASE ORDER
NUMBER:
__________________________________________ |
REQUESTED PART
NUMBER: |
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PART PRICE:
USD $ _______________
(AS QUOTED IN EMAIL) |
SHIPPING CHARGE:
USD $ _______________
(REFER TO OUR WEB SITE) |
TOTAL AMOUNT:
USD $ _______________ |
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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.)
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EXPIRATION DATE:
MONTH_______/YEAR________ |
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SHIPPING
ADDRESS |
BILLING
ADDRESS (IF DIFFERENT) |
NAME |
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ADDRESS |
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CITY, STATE
ZIP CODE |
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COUNTRY |
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PHONE NUMBER |
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EMAIL |
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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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