LanguageQuest - Fax Order Form

ORDER FORM » SHIPPING INFO & RATES (CLICK)

Print and complete this form. Then FAX or MAIL 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) @ 0.0775 (7.75%) $_________

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