Fill out this order/payment form, print and FAX or mail the signed original copy with your payment in U.S dollars to:
FAX: (786) 375-5505
Advantig Corpotation
801 Old Hollow Rd.
Winston-Salem, NC 27105
www.advantig.com
Phone
US: +01 (336) 767-4029 | Canada: +01 (647) 477-6373 | UK: +44 (0) 203 00 28213
*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
.
January (01)
February (02)
March (03)
April (04)
May (05)
June (06)
July (07)
August (08)
September (09)
October (10)
November (11)
December (12)
Year
Billing Zip Code
PayPal Send payment to:
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
Home