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
__