Fill out this order/payment form, print and FAX or mail the signed original copy with your payment in U.S dollars to:
FAX: (800) 839-7684 Advantig Corpotation
3112 Van Buren Dr.
Tampa, FL 33611

www.advantig.com

Phone  US: +01 (813) 419-3547
*Name or Company
*Shipping Address
Address Line 2
*City, State/Province 
*Zip/Postal Code  Country
*Phone number Extension
*E-mail address
 
*Payment Type (fill in only the applicable fields, ie: PayPal & Money Orders skip credit card portion)
Credit Card:  Visa Master Card Discover American Express
Name on card
Credit Card Number CVV/CVC/CIN
  Expiration Month Year   Billing Zip Code
PayPal          Send payment to: sales at advantig
Money order / check #   P.O.# 
C.O.D. This option is only available to U.S destinations and only if Advantig is shipping products.

*UNITS
*DESCRIPTION OF ITEM OR SERVICE           *AMOUNT

TAX (Florida Residents  add 7% sales tax)
S&H are United States destinations per package.  Overseas add $5.00 (Priority shipping not available).
Email (free) First Class  Priority (U.S. only) Shipping & Handling
 Multiple items are usually shipped in a single package. *Total
*Signature
 *Date Take 10% off if you buy within 15 days of your original trial.
* Required Field

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