Sprinco Secure Order Form

SPRINCO USA SECURE ORDER FORM

* - these fields are required

*Name:

*Email:

Daytime Phone:*

Fax:

Address to be shipped to:
Ship to:*

City:*

State/Territory*:

If APO, APO Info:

Zip/Postal Code:*

Shipping Method:

Standard Delivery (UPS Ground / Add $5.75)

UPS Second Day Air (Add $10.75)

Next Day Air (Add $19.75)

Please note that UPS will not deliver shipments to PO boxes.

Please enter the part number, quantity, description and price of each item below.
If you would like, we can enter the price.

Part No	Qty	Description/Model	Price

If you need more room, just submit a second page
and type "Continued" in the very last description box.

Backorders: It is rare but sometimes we are out of products. If we are out of stock on an item, how would you like us to handle it?
Please backorder any out-of-stock items.
Please cancel any backorders and adjust my total.
Please contact me regarding any out-of-stock items.

Method of payment:
Visa
Discover
MasterCard
American Express
Check/Money Order
Sprinco Acct Number:

If Payment is by credit card:
My credit card information is listed to the right
I will fax you my credit card number - (512) 331-9172
I will mail you my credit card number.

Note: We will ship within 24 hours, Monday through Friday.
If we're unable to do so, we'll notify you as soon as possible.

Credit Card Information:
Your name as it appears on credit card

Card Number	Expires

Billing address of credit card*

City, State	ZIP

*This is the address your credit card company sends your bill to; not your credit card company's address. We need this for charge verification.