Calif. Business Name Required if For Resale, Must
Match Above No.
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Telephone No. (Required)
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Email Address (Required)
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SELECT METHOD OF PAYMENT: Select One in
Scrolling Box to Side from following: Money Order,
Personal Check, American Express, Optima, Discover,
Mastercard, VISA, Pay Pal. Credit Cards Must List
Billing Name, Address Above as on Credit Card Billing
Statements- There is a place for shipping to different
address and/or person on this form.
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Select One of the Above & Click to
Highlight
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Credit Card Number (Required for Credit Card Name
To Be as in Billing Name and Address Above)
If you have ordered previously & wish to use
the same card, simply say: "same as before"; be sure
address is up-to-date
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Expiration Date (Required for Credit Card)
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Credit Card Security Code - Last 3 Digits on Back
of VISA, Mastercard, Discover Cards, & newer
AMEX/Optima Cards (may be small letters on front of some
AMEX cards. (Required for Credit Card Payments)
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For Special Instructions that Don't Fit into Form.
For Layaway, Deposit is 1/3 of Total Above - Note
Layaway, FedEx Ground, UPS, DHL, or USPS Shipping Only,
Etc. Enter in boxes to the right. These messages go
through with form even if you cannot send email
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If you do not wish to give out credit card
information over the internet call 714-974-3779 or fax
form to 714-974-0375.
We can also send an invoice to you from either Pay
Pal or Google and that way you can pay securely through
one of those systems.
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If you have already ordered & given a credit
card no. give, type, expiration date, now need security
no. & put on file in the place of Card No.
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