Manual Order Form

First Name:
Last Name:
Company Name:
E-mail:
Phone Number:
Fax:
Shipping Address:
City:
State:
Zip Code:
Country:
CA Resale #:
(Only necessary for California wholesale orders to waive CA sales tax)
Order Description:
 ITEM # DOZENS PIECES
item #1 QTY: QTY:
item #2 QTY: QTY:
item #3 QTY: QTY:
item #4 QTY: QTY:
item #5 QTY: QTY:
item #6 QTY: QTY:
item #7 QTY: QTY:
item #8 QTY: QTY:
item #9 QTY: QTY:
item#10 QTY: QTY:
item#11 QTY: QTY:
item#12 QTY: QTY:
item#13 QTY: QTY:
item#14 QTY: QTY:
item#15 QTY: QTY:
item#16 QTY: QTY:
item#17 QTY: QTY:
item#18 QTY: QTY:
item#19 QTY: QTY:
item#20 QTY: QTY:
Payment Terms:
Credit Card
Please enter your credit card information below. If you prefer, you may also fax your credit card information to us at (626) 396-9348.
Please Select A Credit Card: Visa Mastercard.
Credit Card Holder:
Credit Card #:
Exp. Date:
Billing adrress (if different from shipping address):
Check/Money Order
If you select this payment term, we will e-mail you a confirmation with your order total. Your order will be processed and shipped the next business day after we receive your payment.
Paypal
Please send Paypal payment to: ilottrading@gmail.com
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Additional Orders, Questions or Comments:

FAX ORDER LINE: (626) 396-9348