Print and
Mail with PaymentTV Store
Online
Date:______________________
| ITEM # |
Size |
Quantity |
Cost |
| 1) |
- |
- |
- |
| 2) |
- |
- |
-- |
| 3) |
- |
- |
- |
| 4) |
- |
- |
- |
| - |
- |
- |
SubTotal
(cost of all Items) $____________________ |
| SHIPPING |
------- |
|
Shipping Total:
$_______________ |
| |
|
|
TOTAL
(SubTotal + shipping Total):
$___________________ |
| Payment Method: |
Money Order/Check________ |
Visa/Mastercard__________
American Express/Discover_________ |
| If Credit Card: |
# on Card____________________________ |
Exp Date:______________ |
Mail
to:
Your Name and Address:
Tv Store Online
______________________
24778 Crestview Ct
_______________________
Farmington Hills, MI 48335
_______________________
USA
_______________________
Please makes checks to: Phone:
______________________
TV Store Online Email:
______________________
Fax: (866) 898-3369
