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FAX ORDER FORM       » SHIPPING INFO & RATES (CLICK)


Print and complete this form. Then FAX it to: 530-918-9541
 
BILLING ADDRESS:
 
Name___________________________________________________________________
 
Address_________________________________________________________________
 
City _______________________State _______ Zip _________ Country _______
 
Daytime Phone ____________________ FAX number _____________________________
 
E-Mail Address _____________________________

Payment [ ]MasterCard [ ]Visa [ ]American Express

             [ ]Check - Mail to: Language Quest, 309 N. Mt. Shasta Blvd, Mt. Shasta, CA 96067 USA
 
Credit Card Number __________________________________________________________
 
Expiration Date ________________________Security Code CCV2____________ What's CCV2?
 
Name as it appears on Card __________________________________________________
 
Signature of Card Owner _____________________________________________________
 
ITEMS ORDERED:
 
Item #1 ______________________________________ Price $_________
 
Item #2 ______________________________________ Price $_________
 
Item #3 ______________________________________ Price $_________
 
Item #4 ______________________________________ Price $_________
 
Item #5 ______________________________________ Price $_________
 
Item #6 ______________________________________ Price $_________
 
 
Subtotal: $_________
 
California Sales Tax (California deliveries only) @ 0.0725 (7.25%) $_________
 
Shipping & Handling (See »Shipping Info): $_________
 
TOTAL Charged to your credit card $_________



PHONE: 530-918-9540   FAX:530-918-9541
309 N. Mt. Shasta Blvd, Mt. Shasta, CA 96067 USA

© 2006 LanguageQuest