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1.
DELIVERY ADDRESS
2.
ITEMS TO ORDER
* Please refer to the
shipping & handling costs at http//www.psism.com/order.htm.
Note: If
you would like to prepay by check or wire transfer, please email
first.
If you choose to pay by PayPal,
skip to Section 4 below and we will send you a Money Request via
PayPal.
Credit Card Number
Credit Card's Verification Code
Holder's Name as Printed on Credit
Card
Holder's Phone # if different from
Contact Person
Expiration Date (MM/YY)
Credit Card's Billing Address (This is
the address where you receive your credit card statements.) (Very
Important!)
same
as shipping address
different
(Street No. & Name/ZIP)
Is this credit card a
corporate,
government or
personal card?
If your credit card was not issued in the
U.S., please provide the following info about the bank that issued
it.**
Bank Name
Bank Telephone Number
** There is a 3% (minimum $5.00) surcharge for international
credit cards.
Domestic U.S. Order (pick one):
International Order (pick one):
If you have your own UPS or FedEx account number that
you would like to use, please provide it in the appropriate space
below. If you want to use your account of other courier or use our
FedEx account to ship, please leave note in Section 5.
UPS
or FedEx
* Please
refer to the shipping and handling costs at http://www.psism.com/order.htm.
5.
SPECIAL INSTRUCTIONS /
COMMENTS
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