PoliceSpecial.com
Customer Fax Orders |
Instructions: To place your
order by fax, print this form, then fill out the
appropriate information below. Be sure to include a complete
description of each item including all options such as finish,
weapon fit, color, etc. Also complete the “Ship To” and
“Bill To” sections including your credit card payment
information.
Fax orders are to be submitted to
866.809.5551
Note: Fields that
are in bold are required.
Order Date:
|
Bill To Information
MUST BE CREDIT CARD MAILING
ADDRESS |
Ship To Information
NOT CREDIT CARD ADDRESS |
- First Name:
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- First Name:
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- Last Name:
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- Last Name:
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- Email Address:
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- Email Address:
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- Agency:
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- Agency:
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- Address:
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- Address:
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- City:
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- City:
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- State:
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- State:
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- Zip Code:
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- Zip Code:
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- Phone Number:
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- Phone Number:
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- Fax Number:
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- Fax Number:
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Credit Card |
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- Credit Card Circle One: Master
Card / Visa |
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- Name on Credit Card: |
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- Credit Card Number: |
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-
Billing Zip Code: |
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- V-Code on back of card: |
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- Credit Card
Expires: |
-Signature of card holder:
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Order Detail |
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QUANTITY / ITEM
NAME / PRICE
OPTIONS (COLOR, FINISH, SIZE,
GUN FIT, RIGHT/LEFT HANDED, ETC.) |
1
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2
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3
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4
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5
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6
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When Completed,
Fax To 866.809.5551 |