Step #1 Print out this Order
Form now ......
Step #2 Complete all requested information below (Please PRINT clearly).
Step
#3 Submit your completed order via Facsimile or
Mail including check or credit card information. |
1. CONTACT INFORMATION - for the individual
/ business placing this order.
________________________________ _______________________________ ________________________________
First Name Middle Initial Last Name
__________________________________________________________________________________________________
Address
________________________________________________ __________________________ _____________________
City State/Province Zip/Postal Code |
2. SHIPPING INFORMATION - Complete ONLY if different from
Contact Information above.
________________________________ _______________________________ ________________________________
First Name Middle Initial Last Name
__________________________________________________________________________________________________
Address
________________________________________________ __________________________ _____________________
City State/Province Zip/Postal Code |
3. ADDITIONAL CONTACT INFORMATION - Complete for Order Verification purposes.
(_______)______________________________ (_______)______________________________
Daytime Phone # Evening Phone #
(_______)______________________________ ______________________________________
Fax Phone #
EMail Address |
4. PAYMENT INFORMATION - Please indicate your preferred method of order payment.
[ ] Visa [ ] MasterCard
[ ] American Express [ ] Money Order* [ ] Check*
_______________ _______________ _______________ _______________ ________/________
Credit Card Number Card Expiration Date
_____________________________________________________________
Cardholder Name (exactly as it appears on Credit Card identified above)
_____________________________________________________________
Cardholder Signature |
5. TO SUBMIT YOUR ORDER FOR PROCESSING
Mail the completed order form and include credit card info or make payment of
personal/cashier's check or money order to: |
Don McDonald
1809 Atchison Drive
Norman, Oklahoma 73069
Phone: (405) 364-9139
Toll Free: 1-800-848-0373
Fax: (405) 364-7914
Brochures available $2.00
Email: ctn@telepath.com
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Order Details - next page......
- Order Details -
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