BOOK
INFORMATION
Customer Information
|
Credit
Card Number (is it Visa
, Master Card
, Discover
,
American Express
other
?)__
|
| Expiration
Date (mm/yy)—
_ |
| Customer
Name (as it appears on the card)__
|
Billing
Address
|
| Zip___
|
| 
Total Amount (including any taxes, duty, shipping charges)_____
|
What
Currency (US
, Canadian
, English
, Australian
)
(should be US if possible) |
| Customer
Order # (PO, or Invoice #)_______
|
| CW2
(Security numbers on the back of the card as
written with appropriate spaces if any)
|
| Approximate
Ship Date__
|
|
|